[ilovetv]

Originally Posted by blueash

Curious and seeking data from those who claim that a hospital cannot survive when the overwhelming number of their patients are medicare. From what I am lead to believe, perhaps wrongly, TVRH has almost zero non-paying patients while most other hospitals have huge numbers of them. They also have almost no Medicaid patients, and Medicaid pays significantly lower than Medicare for the same service. So if TVRH does not have either of these two major financial sinkholes, I would have thought that having nearly all your patients paying rates very similar to those commercial carriers provide would be wholly sufficient.

What you say seems correct, but I think it leaves out a key factor at TVRH in particular because of the disproportionately high number of patients who are on Medicare and are chronically ill in their last two years of life--the time in life when a patient's care produces the highest Medicare expenditures:

Medicare spending per patient during the last two years of life

Overall, the average spending per chronically ill Medicare patient in the last two years of life increased 15.2 percent from $60,694 in 2007 to $69,947 in 2010.

In 2010, spending rates per Medicare beneficiary varied from a high of $112,263 in Los Angeles, Calif., to a low of $46,563 in Minot, N.D.From 2007 to 2010, Bloomington, Ill., was the only region in the nation showing a decrease in spending, as spending per Medicare patient decreased from $57,802 in 2007 to $53,674 in 2010....

Patients seeing 10 or more doctors during the last six months of life

Overall, chronically ill patients were significantly more likely to be treated by 10 or more doctors in the last six months of life in 2010 than they were in 2007, as the national rate increased from 36.1 percent to 42 percent.

In 2010, patients in East Long Island, N.Y. received the most intensive care by this measure, with 62.3 percent of patients seeing 10 or more doctors in the last six months of life.

Other regions with high rates included Ridgewood, N.J. (62.1%) and Royal Oak, Mich. (60.2%). Regions with low rates included Idaho Falls, Idaho (14.5%), Grand Junction, Colo. (17.7%), and Missoula, Mont. (18.2%). Only seven regions decreased in this measure from 2007 to 2010, including Neenah, Wis. (from 25.2 percent in 2007 to 21.4 percent in 2010) and Santa Cruz, Calif. (from 31.8 percent in 2007 to 28.9 percent in 2010).

- See more at: The Dartmouth Institute » Barbara A. Koll, MS

Another illustration:

Why 5% of Patients Create 50% of Health Care Costs

While there are various ways to reduce the costs of health care, this fact (Cohen & Yu, 2012 Agency for Healthcare Research and Quality) should make you stop in your tracks: most business people have an 80/20 rule they apply in a variety of settings (20% of your customers generate 80% of your volume, etc.). This rule tells us that an enormous amount of the health system cost is centered in a very concentrated group of people. Who are they, why are they so expensive, and can we address this relatively small population to the benefit of the whole?

This is when the discussions about courage and character by lawmakers, practitioners and patients moves front and center. These patients tend to be newborns with serious issues and the elderly, who are often quite ill. According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life......

Why 5% of Patients Create 50% of Health Care Costs - Forbes

And meanwhile, Medicare underpays compared to costs of providing the care. I think the high concentration of aged, chronically ill Medicare patients in their last two years of life hits TVRH extremely hard, financially.