Tuesday, January 21, 2014

Assignment Blog 2 for my students

"Modern Healthcare" recently reported the closure of Interfaith Medical Center in Brooklyn, New York. Interfaith Medical Center, like Grady Memorial Hospital in Atlanta, is/was a large "safety-net" hospital. Interfaith primarily treated patients on Medicaid and uninsured patients. It has been in financial strain for some time.

http://www.modernhealthcare.com/article/20140118/MAGAZINE/301189967?AllowView=VXQ0UnpwZTVDL1dXL1I3TkErT1lBajNja0U4VUMrZFZFQk1HQXc9PQ==

The question, of course, becomes, where will those patients now received needed medical care. At least two things catch my attention in this regard. The first is that this hospital may have survived had "Obamacare" been implemented sooner. In other words, by participating in the exchanges and tapping federal revenues available to help people afford health insurance, the patients served by Interfaith would have had more resources to be spent for medical care. Also, the hosipital itself apparently could have sponsored its patients by paying their premiums for insurance under the new laws and policies.

The article notes that hospitals with high debt, low occupancy and less acutely ill patients are more likely to close. Well, under the new law, if Interfaith Medical Center had become part of an Accountable Care Organization, perhaps more of its revenues whould have come through capitation and its low occupancy rates would not have been a major problem.

This bring up the question of the role of hospitals (and safety net hospitals in particular) in the future of healthcare delivery in the United States. Many people see hospitals as the "hubs" of Accountable Care Organizations (ACOs). Others see a more fluid situation in which ACOs are not dependent upon hospital systems as "hubs."

It seems to me that to effectively protest the closing of a major safety net hospital requires more than a wish to return to the past. An effective protest, I think, requires an understanding of the future of healthcare delivery in the United States. Without that understanding, then it is not possible to anticipate how existing institutions can fit into the new realities and survive.

Students, please see what you can find regarding safety net hospitals and Accountable Care Organizations and then reflect upon the situation reported in this recent article in Modern Healthcare. Comment here, as before.

9 comments:

  1. Safety net hospitals treat all patients regardless if they insurance or not. I read one article where a patient that was suffering from heart failure refused to go to the hospital because it was a safety net hospital. His argument was of the environment he felt that the quality of care was poor. According a study in this article they found that hospitals that were not safety net had more problems with malpractice than that of non-safety net hospital. What I took out of that article was that perhaps may be due to lack of patients with insurance some safety net hospitals may be closing because some of the paying patients refuse to get treated there. On the other hand in another article I read suggested that due to Obama care , safety net hospitals are in danger of closing because funding that they would receive from federal grants would not be available because they are helping with insurance. The article states the affordable care act creates a gap that leaves safety-net hospitals without any funding.
    My understanding of Accountable Care Organizations is that they focus on keeping patients healthy and out of the hospitals. Georgia has two locations one in Athens and the other in Savannah. ACO’s are said to “improve care for Medicare beneficiaries and slow rising costs by changing the incentives that influence how doctors and hospitals operate. Participation is voluntary for both providers and patients” (Andy MillerPublished: Apr 11, 2012).
    See more at: http://www.georgiahealthnews.com/2012/04/georgia-role-medicare%E2%80%99s-accountable-care/#sthash.zTfeVouk.dpuf
    well.blogs.nytimes.com/2012/09/06/the-fraying-hospital-safety-net
    www.nbcnews.com/id/32672409/ns/health-health_care


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    1. Thank you, Angela. As I read your comment I though about the fact that many homeless people prefer to be on the street at night than in shelters, apparently because they feel safer on the streets. It is sad if some safey net hospitals have a poor reputation. I am thankful that I have been able to avoid emergency departments and that the couple of times long ago I went to an emergency department years ago, the facility was clean and service was good. I did not realize that there are already two ACOs in Georgia. Thank you for that information!

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  2. A safety net hospital or health system provides a significant level of care to low-income, uninsured, and vulnerable populations. Safety net hospitals are not necessarily distinguished from other providers by ownership – some are publicly owned and operated by local or state governments and some are nonprofit. Currently, Medicaid DSH [Disproportionate Share Hospital program] disburses $11.5 billion annually to the states, which have considerable latitude in allocating these funds. Some states carefully target their DSH payments to hospitals providing large volumes of uncompensated care, but others, such as Ohio and Georgia, spread their payments broadly, transforming the program into a de facto subsidy of their hospital industry. If properly enforced, the proposed rule will help sustain the safety net. But if the state governments that refused to expand Medicaid also refuse to rethink their approach to allocating DSH funds, there will be little money left to sustain their safety-net hospitals when the cuts deepen in 2017. The cascade of service reductions and facility closures that this could trigger would have sweeping consequences. The proposed DSH rule is a good start, but much remains to be done.

    http://www.ilr.cornell.edu/healthcare/Resources/upload/WhatIsASafetyNetHospital.pdf
    http://theincidentaleconomist.com/wordpress/safety-net-hospitals-at-risk/

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  3. Despite the criticism that Safety Net Hospitals receive, in low income communities such as i grew up in, they can be considered as a life saver especially for those who are not insured. Although the quality of service may not be grade A, most patients would rather have someone look at them than for no one at all. When i was 17 i was in a car wreck and broke my femur and had to go to the hospital with no insurance. At first my parents were skeptical about which one i should get go to but without insurance, a hospital in Brunswick politely admitted me and treated me with the best care they could produce. Yes, there were a few things i felt they could have did better but I couldnt complain due to the fact that i did not have insurance and they still took care of me.
    My understanding of ACOs is Accountable Care Organizations are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

    http://www.medicare.gov/manage-your-health/coordinating-your-care/accountable-care-organizations.html

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    1. Thank you, Joe, for sharing both your insights and your experience.

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  5. Safety net hospitals are quite commonly used by most of Americans and it has been this way for many years. Safety net hospitals have been the pipeline for efficient healthcare services provided for the less fortunate Americans in highly populated cities. I read in a few articles that the medicare budget provided federally to safety net hospitals has a small responsibility in keeping the bills paid. Safety net hospitals are frowned upon by some consumers whom have insurance solely upon their disbelief of the quality of services. I predict that Obama care will possibly save some of the remaining safety net hospitals if there is a clear understanding of the most efficient way to compensate the consumer as well as the institution. The ACO from what i read is the best thing for elderly patients since the invention of slice bread! It provides a continuum of the patients health history as well as a system that the respective billing department can follow. I also read that the consumer will be notified by the physician if they are a member and can opt out if they desire. http://www.youtube.com/watch?v=zQIf2ggEp6s&feature=player_detailpage

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