Don't Like The TVRH-ER Now? It's Going To Get MUCH, MUCH Worse...

[Mack184]

For as long as I have been reading TOTV there have been pages upon pages of gripes about the waits and care at the TVRH-ER. The vast majority of these gripes come from people who have virtually no knowledge of how a hospital functions in general and an ER in specific. Most of the "knowledge" in these gripes come from people who have watched too many episodes of Marcus Welby, ER, Trapper John MD, Diagnosis Murder, MASH or St. Elsewhere and think that's reality.

Both Russ Boston and I have repeatedly told the story that TVRH's problems are three-fold. A lack of beds, a lack of staff and a dwindling revenue stream due to TVRH being heavily dependent on Medicare reimbursements that are being continually reduced. Most of the complainers don't like these facts and they prefer to stick to their fantasies of why TVRH does not conform to their world.

What I am now about to say is NOT rumor or conjecture, nor have I been busy playing a tune on the opium pipe. This is the truth. Taken DIRECTLY from a letter to the TVRH professional staff from the hospital administration.

According to that letter the hospital is facing a 5 million dollar operating deficit as they go into their next fiscal year. The letter indicates that the deficit will grow as more cuts take effect as directed by the Federal Affordable Care Act.

After "serious thought" the hospital administration has effectively decided to balance their books on the back of the hospital nursing & professional staff!

What this means is that TVRH will no longer grant pay bonuses for experienced nurses who have advanced education and certifications. The vast majority of hospitals pay percentage bonuses to nurses who upgrade their degrees, get advanced certifications in important care areas such as Emergency/Trauma, Critical Care, OR and so on. Those types of bonuses help to assure that a hospital will attract the best and the brightest. The fact that TVRH will no longer provide that sort of financial bonus puts a HUGE "unwelcome" sign out to quality, experienced nurses and other professionals. It also puts the pay level down to a point where the only people who will likely look for a job at TVRH are fresh, green graduate nurses.

This is not to bad mouth those new young grads. But as in so many other professions you need a balance. The older, more experienced nurses are able to mentor young people just out of college making them better, more effective healthcare givers.

TVRH pay for professional nurses is some of the lowest in the profession. People who have come south from any comparable sized hospital in the north or west have found that the pay is 30-50% lower for the same job that they were doing. That is not exactly a big incentive to work at TVRH.

Recently there was a front-page article in The Daily Sun announcing that the hospital would soon open many more beds. Fine. One problem. Staffing. They cannot currently attain correct staffing levels at the hospital. They have a giant turnover due to the low pay and chaos in the hospital ER. So how exactly are they going to staff all these new rooms when they cannot currently safely staff what they have?

With the decision by the hospital administration to balance it's books on the backs of the nursing staff, it's going to make it doubly hard to keep qualified, experienced nurses to staff what they have now. The idea that they will somehow come up with even more staff at lower pay levels than they pay now is pure folly.

Furthermore the letter goes on to cap the amount of accrued vacation, sick & personal time for long-time employees and in some cases outrightly steals accrued time from them.

They go on to say about some of "wonderful" extra benefits they have added to make up for this, which of course don't amount to anything but a handful of magic beans.

The bottom line is, that TVRH is going to attract less and less professional people in general and far less experienced staff in specific. If you don't like the present, you're going to HATE the future!

Not enough beds, not enough staff, poorly paid staff, dwindling revenue. And so it goes.

[jbdlfan]

Just curious, do you see this as a problem state-wide or unique to TV due to the age of the population? My wife is venturing into the profession as a mid-life career change. It's nice to stay informed!

[The Buckeyes]

I don't dispute any of the claims but it is hard to believe deficits are so high when on March 16th I visited the er and was seen a PA (physicians assistant) for no more than 10 minutes who spent at least half that time trying to figure out the computer program to enter info. Botton line my insurance company was charged $779.00 for this! Can you imagine what the cost would have been if I was seen by a "REAL" doctor?

[gomoho]

I don't dispute any of the claims but it is hard to believe deficits are so high when on March 16th I visited the er and was seen a PA (physicians assistant) for no more than 10 minutes who spent at least half that time trying to figure out the computer program to enter info. Botton line my insurance company was charged $779.00 for this! Can you imagine what the cost would have been if I was seen by a "REAL" doctor?

What your insurance company was billed and what they paid are usually two different matters and usually the difference between night and day.

[Mack184]

Just curious, do you see this as a problem state-wide or unique to TV due to the age of the population? My wife is venturing into the profession as a mid-life career change. It's nice to stay informed!
While the brave new world of the "Affordable Care Act" is making for new surprises virtually every single day in the healthcare world, TVRH has the dubious honor of receiving more per-capita medicare dollars than any other US hospital. Fully 88% of their revenue stream comes from Medicare where the US average is around 36-40%. Since many other hospitals can boost their bottom line with elective surgeries, maternity, pediatrics and so on, TVRH cannot. It's P-1 demo is 65+ and Medicare is the payer. It's not an enviable position to be in.

As far as your wife is concerned, if she doesn't mind driving, she'll do better elsewhere..but..if she's just starting out, no matter what her age she's a "new grad" which means she'll be at the bottom of anybody's pay scale.

[ilovetv]

I don't dispute any of the claims but it is hard to believe deficits are so high when on March 16th I visited the er and was seen a PA (physicians assistant) for no more than 10 minutes who spent at least half that time trying to figure out the computer program to enter info. Botton line my insurance company was charged $779.00 for this! Can you imagine what the cost would have been if I was seen by a "REAL" doctor?

This mess (all medical orders by computer) is what is mandated by government, for all hospitals and providers, and the software is designed and sold by many different companies making it different in every clinical setting and thus, a nearly insurmountable learning curve for every nurse, PA, doctor to wrestle and beat into submission WHILE they are trying to take care of a patient---AKA "a PERSON who is sick and vulnerable and in need of a doctor, not a data entry technician with eyes fixed on a computer". Also, the software is billing oriented, and NOT patient care oriented.

But unknowing people keep on voting for campaign promises of government-only, single-payer healthcare, and this is what we're getting. And it's only just begun.

[Mack184]

This mess (all medical orders by computer) is what is mandated by government, for all hospitals and providers, and the software is designed and sold by many different companies making it different in every clinical setting and thus, a nearly insurmountable learning curve for every nurse, PA, doctor to wrestle and beat into submission WHILE they are trying to take care of a patient---AKA "a PERSON who is sick and vulnerable and in need of a doctor, not a technician with eyes fixed on a computer". Also, the software is billing oriented, and NOT patient care oriented.

But unknowing people keep on voting for campaign promises of government-only, single-payer healthcare, and this is what we're getting. And it's only just begun.
My wife refers to this computer mess as "Caregiving By The Pinks". At her previous hospital any computer item that wasn't filled out came up the color pink. So mostly the people were trying to make sure there weren't any "pinks" on the computer. Didn't really matter if the patient died, as long as the "pinks" were filled in. Then, in the case the hospital got sued, they could pull their computer transcripts and proudly announce that everything was A-OK!

[dotti105]

I am a RN with 20+ yrs experience and am building a home in Gilchrist. I love my job and have considered working part time after we move. But after seeing the salary at TVRH, I know I will be commuting, probably to Orlando, to work a couple of days a week.
Salaries do vary by region, and Nursing has always paid very low in Florida. But TVRH is exceptionally low.
I agree that hospitals need to compensate the experienced among us in order to assure excellent care today and tomorrow. There is no way to place a monetary value on an experienced, well seasoned bedside RN. And as a RN I want to work with others who are also experienced so that newer nurses can be mentored and draw upon the experience of the team as a whole.
Experienced nurses are working because they love the career AND because they need/want the paycheck. If they are not compensated fairly, they will leave, choosing instead a hospital that values (pays) them more.
That is the cold hard truth!
Sad state of affairs at TVRH.

[Indydealmaker]

I predict that this problem will spread across the nation to all hospitals as private insurers pressure healthcare providers for lower costs to offset the new government regulations. The future is less care for more cost, just like any other government structure.

[blueash]

. The future is less care for more cost, just like any other government structure.

Not so sure about that low cost for government payment to private companies. I do believe that Mr. Snowden, a high school dropout, was paid $122,000 / yr as a starting salary at his job. <snark>

[ilovetv]

Not so sure about that low cost for government payment to private companies. I do believe that Mr. Snowden, a high school dropout, was paid $122,000 / yr as a starting salary at his job. <snark>

That, too.

[ilovetv]

I am a RN with 20+ yrs experience and am building a home in Gilchrist. I love my job and have considered working part time after we move. But after seeing the salary at TVRH, I know I will be commuting, probably to Orlando, to work a couple of days a week.
Salaries do vary by region, and Nursing has always paid very low in Florida. But TVRH is exceptionally low.
I agree that hospitals need to compensate the experienced among us in order to assure excellent care today and tomorrow. There is no way to place a monetary value on an experienced, well seasoned bedside RN. And as a RN I want to work with others who are also experienced so that newer nurses can be mentored and draw upon the experience of the team as a whole.
Experienced nurses are working because they love the career AND because they need/want the paycheck. If they are not compensated fairly, they will leave, choosing instead a hospital that values (pays) them more.
That is the cold hard truth!
Sad state of affairs at TVRH.

The well seasoned bedside RN is being pushed aside by cheaper, computerside staff who have grown up with their eyeballs screwed into a computer and smart phone screen, and typing with their thumbs.

Actually, a robot is what is demanded by this growing (nation-wide) "System".....Not a thinking, caring human being.

[Chazz]

Very disturbing!

[rubicon]

Mack184 your post (#1) is very disturbing and brings into question the media blitz in the Daily Sun about the Marcus Welby Center.

Blueash Snowden was making $200,000 and was only holding a GED.
( source WSJ) Mack184 I am sorry you and the other staff are facing those challenges.

To all of us God help us when the Affordable Healthcare law takes hold.

[Mack184]

Mack184 your post (#1) is very disturbing and brings into question the media blitz in the Daily Sun about the Marcus Welby Center.

Blueash Snowden was making $200,000 and was only holding a GED.
( source WSJ) Mack184 I am sorry you and the other staff are facing those challenges.

To all of us God help us when the Affordable Healthcare law takes hold.
I am not on staff there. Russ Boston is. My wife is an NP, although not at TVRH. However like any profession there is a grapevine and a friend shared the hospital letter with her asking for her advice. That's how I know.

[Mack184]

I don't dispute any of the claims but it is hard to believe deficits are so high when on March 16th I visited the er and was seen a PA (physicians assistant) for no more than 10 minutes who spent at least half that time trying to figure out the computer program to enter info. Botton line my insurance company was charged $779.00 for this! Can you imagine what the cost would have been if I was seen by a "REAL" doctor?
I wanted to make a point about how you classed the PA vs. a "REAL" doctor. NPs & PAs are not the medical version of shade-tree mechanics. These people have very serious education and experiential backgrounds. Most states require either a long experience as a nurse, at least an MS and in some cases a PhD or all of the above.

Over the years I don't know how many times my wife has pulled a new 'REAL" doctor's onions out of the fire because he prescribed something that he shouldn't have because he lacked the experience that she had.

Do you need a heart stent? Yep..you should see a really good cardiologist. Need basic medical care? There are many, many fine NPs & PAs who are better set to help you.

As always..choose the right tool for the right job!

[rubicon]

I am not on staff there. Russ Boston is. My wife is an NP, although not at TVRH. However like any profession there is a grapevine and a friend shared the hospital letter with her asking for her advice. That's how I know.

Mack184: Suffice to say I have experienced more than my share of hospitals and I can tell you I have always held nurses in high esteem. It never ceased to amaze me how nurses could work through an entire shift under some the gravest situations dealing with overbearing patients elitist acting doctors and cries and complains of people suffering and yet maintain a positive upbeat attitude. The nursing profession is the one profession I'd always believed was under appreciated and under paid.

So God Bless your wife and Russ Boston. Bravo to them both and their families.

By the way I found that I the news world mad a correction and blueash is right Snowden made $122,000...still too much for him

[Golfingnut]

Must the the reason the parking lot for the staff is filled with Mercedes and Cadilacs.

[Mack184]

Must the the reason the parking lot for the staff is filled with Mercedes and Cadilacs.
And old pick-ups and Kias, Mazdas, Chevys, Fords, Buicks, Hondas and so on.

[njbchbum]

I wanted to make a point about how you classed the PA vs. a "REAL" doctor. NPs & PAs are not the medical version of shade-tree mechanics. These people have very serious education and experiential backgrounds. Most states require either a long experience as a nurse, at least an MS and in some cases a PhD or all of the above.

Over the years I don't know how many times my wife has pulled a new 'REAL" doctor's onions out of the fire because he prescribed something that he shouldn't have because he lacked the experience that she had.

Do you need a heart stent? Yep..you should see a really good cardiologist. Need basic medical care? There are many, many fine NPs & PAs who are better set to help you.

As always..choose the right tool for the right job!

mack - i used to share your opinion of pa/np since i was seen by a pa in the villages last year and the diagnosis was spot on - problem was a relatively common one.

but then i recently went to my personal physician here at home and was seen by his 'well experienced' np. she diagnosed arthritis flare up when, in fact, it was an occurence of the same problem i had in the villages. good thing that i knew what it was and could diagnose and explain to her what it was! bottom line, i asked for the script based on the prior occurence and she wrote it!

good and bad/smart and smarter wherever we go - can't be helped. i have always remembered my father's advice - doctor's only practice medicine - be careful who you let practice on you! ;)

back on target with this thread - tvrh would do well to implement extended hours at their urgent care faciity and shuttle patients that come to the e.r. but can be seen at the u.c. center.

[Peggy D]

Why does everyone blame the Federal Affordable Care Act? What is being predicted for the future is taking place NOW!
I worked for an intercity hospital that was a private hospital. Many years ago, it came down that we had to accept anyone who walked through the door--insurance or none. Guess what? Services, pays and positions were cut to make up for lost revenue. Nothing new.

As for the Villages Hospital, I have always defended them in the past, knowing first hand how busy the ED is. But that changed after my son was visiting and was injured. After being triaged, he sat in the waiting room for 4 hours with a closed head injury. That injury takes priority over someone with a cough for two weeks--go to your doctor. Shame on them.
It wasn't until he identified himself as an RN did they consider doing a CATscan!!

[Happinow]

This is very scary. I think the bottom line in health care today is money. While there may be caring medical staff, it all comes down to revenue and I don't think that they really care if we live or die as long as they can make a profit. That's just how I look at health care today. I hope I continue to stay healthy!

[Irishmen]

This is very scary. I think the bottom line in health care today is money. While there may be caring medical staff, it all comes down to revenue and I don't think that they really care if we live or die as long as they can make a profit. That's just how I look at health care today. I hope I continue to stay healthy!

So true Happinow. God Bless us all!

[TraceyMooreRN]

Why does everyone blame the Federal Affordable Care Act? What is being predicted for the future is taking place NOW!
I worked for an intercity hospital that was a private hospital. Many years ago, it came down that we had to accept anyone who walked through the door--insurance or none. Guess what? Services, pays and positions were cut to make up for lost revenue. Nothing new.

As for the Villages Hospital, I have always defended them in the past, knowing first hand how busy the ED is. But that changed after my son was visiting and was injured. After being triaged, he sat in the waiting room for 4 hours with a closed head injury. That injury takes priority over someone with a cough for two weeks--go to your doctor. Shame on them.
It wasn't until he identified himself as an RN did they consider doing a CATscan!!

I am surprised by the fact that you knew "the cough for two weeks" went first. I can't imagine what it feels like to have a child injured (no matter what age) and then have to wait. However--please know there is protocol for triage--not just coughing. Yes--patients who can see urgent care or their MD need to go and leave the ER for true emergencies....:beer3:

[Peggy D]

I am surprised by the fact that you knew "the cough for two weeks" went first. I can't imagine what it feels like to have a child injured (no matter what age) and then have to wait. However--please know there is protocol for triage--not just coughing. Yes--patients who can see urgent care or their MD need to go and leave the ER for true emergencies....:beer3:

Of course people around you in the ED waiting room ask what you're there for and are so willing to tell you what their ailment is. That's how I knew she had had a cough. This was not an elderly person, or I would have been more concerned. She wasn't in any distress.
I agree, those non-emergencies need to be seen by a physician or attended to by urgent care but that's where the problem lies, People use the ED as a physician's office.

I am aware there is a triage protocol, but where I've worked, a head injury
is more serious and takes priority. Trust me, I've seen bad outcomes from such injuries.

[The Buckeyes]

I wanted to make a point about how you classed the PA vs. a "REAL" doctor. NPs & PAs are not the medical version of shade-tree mechanics. These people have very serious education and experiential backgrounds. Most states require either a long experience as a nurse, at least an MS and in some cases a PhD or all of the above.

Over the years I don't know how many times my wife has pulled a new 'REAL" doctor's onions out of the fire because he prescribed something that he shouldn't have because he lacked the experience that she had.

Do you need a heart stent? Yep..you should see a really good cardiologist. Need basic medical care? There are many, many fine NPs & PAs who are better set to help you.

As always..choose the right tool for the right job!

My point was the amount charged by the hospital for 10 minutes of work of which half was self training on a computer program. Don't you think that is absurd for a person that does not even have an MD behind his/her name!

[The Buckeyes]

What your insurance company was billed and what they paid are usually two different matters and usually the difference between night and day.

This is very true...my point was the absurd amount charged and if I or you did not have insurance we would be expected to pay that ridiculous charge!

[ilovetv]

This is very true...my point was the absurd amount charged and if I or you did not have insurance we would be expected to pay that ridiculous charge!

This is a good illustration of how, when "somebody else" pays the bill i.e. insurance both public and private, there is no reason/incentive for the patient to seek out the most economical or cost-effective place or way to get treated.

[Russ_Boston]

Just want to verify what the OP said in the first post. Got the letter the other day.

One thing to clear up though: TVRH is not alone in Central FL as it relates to poor pay and benefits. All the other hospitals I checked out in the 30 mile radius around TV (Ocala, Monroe, Waterman, Citrus, Clermont etc.) are the same or EVEN WORSE!

It is possible to get a job or a travel job in Orlando but the base is really not that much higher unless you have a steady travel RN gig.

But it is what it is and I don't get those benefits that were cut so it (the new cuts) didn't effect me at all.

[asianthree]

its not just in fl other states are going thru the same thing

[wendyquat]

I predict that this problem will spread across the nation to all hospitals as private insurers pressure healthcare providers for lower costs to offset the new government regulations. The future is less care for more cost, just like any other government structure.

:agree:

[Mack184]

Just want to verify what the OP said in the first post. Got the letter the other day.

One thing to clear up though: TVRH is not alone in Central FL as it relates to poor pay and benefits. All the other hospitals I checked out in the 30 mile radius around TV (Ocala, Monroe, Waterman, Citrus, Clermont etc.) are the same or EVEN WORSE!

It is possible to get a job or a travel job in Orlando but the base is really not that much higher unless you have a steady travel RN gig.

But it is what it is and I don't get those benefits that were cut so it (the new cuts) didn't effect me at all.
Russ..to be fair..the hospital administration letter tried to convey the idea that nobody could find a better deal anywhere around. Maybe at the time you were looking you couldn't find anything better either, I don't know. You're an honest man, and I have no reason to doubt what you say. All I know is that my wife DID find a better deal and took it.

But I do think it is both fair and correct to point out that TVRH by changing it's policies is going to make it harder for the hospital to find, attract and keep the best and the brightest. I think you might agree with that.

[Russ_Boston]

Russ..to be fair..the hospital administration letter tried to convey the idea that nobody could find a better deal anywhere around. Maybe at the time you were looking you couldn't find anything better either, I don't know. You're an honest man, and I have no reason to doubt what you say. All I know is that my wife DID find a better deal and took it.

But I do think it is both fair and correct to point out that TVRH by changing it's policies is going to make it harder for the hospital to find, attract and keep the best and the brightest. I think you might agree with that.

Agree Mack.

Why not share where your wife found a better deal. I'm not married to any place. At least you could send a PM with the details. Thanks.

[graciegirl]

Russ..to be fair..the hospital administration letter tried to convey the idea that nobody could find a better deal anywhere around. Maybe at the time you were looking you couldn't find anything better either, I don't know. You're an honest man, and I have no reason to doubt what you say. All I know is that my wife DID find a better deal and took it.

But I do think it is both fair and correct to point out that TVRH by changing it's policies is going to make it harder for the hospital to find, attract and keep the best and the brightest. I think you might agree with that.

I am not challenging you, but I have to ask, how can a hospital meet a financial deficit? When the financial climate was tough in industry and the bottom line couldn't be met, hours got cut and people lost some perks and some people were let go.

You can't continue in the red indefinitely. It is obviously NOT an easy solution and something has got to give. Or SOMETHING needs to be refigured. I wish that the cost of charges for any hospital services were the same for the uninsured as they are for the insurance companies...to begin with and that medications were not so extravagantly expensive, although I know the cost of developing medicine is astronomical.

I can wish too. Not an easy answer at all it seems.

[Dr Winston O Boogie jr]

My point was the amount charged by the hospital for 10 minutes of work of which half was self training on a computer program. Don't you think that is absurd for a person that does not even have an MD behind his/her name!

The problem is that insurance companies bring in huge amounts of business to a health care facility. If the facility wants that business that business, they have to give the insurance companies deep, and I mean very deep, discounts on their charges. The facilities know this so they set their prices so that they will get as much as they can without losing the business. My company sends me a form every time I see a doc or have some kind of treatment or procedure. I recently had something done and the bill looked something like this; Amount charged, $7500, amount paid by insurance company $82.00 amount owed by me, $8.00.

I was just in the hospital for a procedure a few months ago and the bill was for $80,000. I paid my $225 deductible and the insurance company paid about $1100.

What hospitals are charging is meaningless. What they are receiving for their services is very different. Medicare has recently lowered the amount that they will pay. And the Affordable Act will lower these payments even more.

Insurance companies pay a percentage of the charges and it is a very low percentage. Medicare just lowered that percentage and the AFCA will lower it even more.

[Dr Winston O Boogie jr]

The best and the brightest are not going to be coming to work at the Villages Hospital or any hospital in Central Florida.
Most of the best and brightest want to work at the best hospitals in the world. They are going to places like Boston, New York and Chicago. True places like Massachusetts General pay more, but medical professionals want to work there for more reasons than higher pay. They love being ont he cutting edge. They want to be associated and work beside the best in their field.

Many are young people who want to be around other bright young professionals. They want to live in the big cities where they have a social life and they are challenged by the most interesting cases.

That's not a rap on the medical professionals that we have here. I'm sure that many of them are very fine competent professional and can take care of most of our needs. But think that we are going to attract the very top of the field by offering a few more dollars is a bit naive.

People come here to retire because the weather is great and because the cost of living is low. With low cost of living comes low wages. Medical professional might want to come here if they are specializing in gerontology but not for many other reasons. If they like the warm weather and enjoy working with the elderly and problems specifically related to aging they are going to come here.

[3puttharry]

While the brave new world of the "Affordable Care Act" is making for new surprises virtually every single day in the healthcare world, TVRH has the dubious honor of receiving more per-capita medicare dollars than any other US hospital. Fully 88% of their revenue stream comes from Medicare where the US average is around 36-40%. Since many other hospitals can boost their bottom line with elective surgeries, maternity, pediatrics and so on, TVRH cannot. It's P-1 demo is 65+ and Medicare is the payer. It's not an enviable position to be in.

As far as your wife is concerned, if she doesn't mind driving, she'll do better elsewhere..but..if she's just starting out, no matter what her age she's a "new grad" which means she'll be at the bottom of anybody's pay scale.

Two very interesting post Mack. Thanks. We love TV but NOW are totally convinced we made the right decision ... down size twice, a villa here and a similar house up north near our kids/grandkids which also allows us to keep our northern hospital and doctors. Makes sense... to be successful, hospitals/doctors/nurses need customer diversification like all other industries.

[janmcn]

These cuts at the local hospitals might not have happened if the Florida Legislature had not just rejected 55 billion federal dollars to expand Medicaid over ten years. Now these tax dollars, earmarked for Florida, will go to other states who will expand Medicaid, while almost one million people in Florida will remain uninsured.

The hopitals lose because they have to continue to treat the uninsured for free, while other states receive billions of dollars.

It's a lose, lose for everybody except for the members of the Florida House of Representatives who continue to pay $8.24 per month for their tax-payer subsidized health care. Wouldn't the Medicaid eligible uninsured love to have health insurance for $8.24 per month, or $30 per month for a family.

[jbdlfan]

These cuts at the local hospitals might not have happened if the Florida Legislature had not just rejected 55 billion federal dollars to expand Medicaid over ten years. Now these tax dollars, earmarked for Florida, will go to other states who will expand Medicaid, while almost one million people in Florida will remain uninsured.

The hopitals lose because they have to continue to treat the uninsured for free, while other states receive billions of dollars.

It's a lose, lose for everybody except for the members of the Florida House of Representatives who continue to pay $8.24 per month for their tax-payer subsidized health care. Wouldn't the Medicaid eligible uninsured love to have health insurance for $8.24 per month, or $30 per month for a family.

The problem with this thinking is the same problem going on in education. Once you accept that Federal money, you now have to adjust your budget accordingly. What happens next year or the year after when the Federal funds are no longer there? Now you have a budget shortfall that is even worse! Just look at Marion County School District.

[ilovetv]

These cuts at the local hospitals might not have happened if the Florida Legislature had not just rejected 55 billion federal dollars to expand Medicaid over ten years. Now these tax dollars, earmarked for Florida, will go to other states who will expand Medicaid, while almost one million people in Florida will remain uninsured.

The hopitals lose because they have to continue to treat the uninsured for free, while other states receive billions of dollars.

It's a lose, lose for everybody except for the members of the Florida House of Representatives who continue to pay $8.24 per month for their tax-payer subsidized health care. Wouldn't the Medicaid eligible uninsured love to have health insurance for $8.24 per month, or $30 per month for a family.

There is much more to this story than our state just accepting this "gift" from the feds:

Costly expansion wouldn't improve Floridians' health
May 17, 2013|By Bob Williams Guest columnist

The state Legislature's decision this year to reject Medicaid expansion was the correct decision for Florida. There is little evidence that growing the health-care program for the poor would improve the health of state residents.

A recent study in the New England Journal of Medicine is all the proof that Sunshine State legislators needed to reject Medicaid expansion. Those lamenting the failed implementation of this part of the federal Affordable Care Act in Florida can look to Oregon to see that Floridians won't be missing out on much.

Oregon expanded Medicaid coverage in 2008 by a lottery, allowing researchers to conduct the gold standard of all studies — a randomized, controlled test of the program. The study showed that when it came to health outcomes, the only improvement found for those receiving Medicaid was in mental health.

New Medicaid recipients showed no significant improvement over those who did not receive coverage when it came to blood pressure, cholesterol levels and blood-glucose levels. Medicaid coverage did not even have a significant effect on the diagnosis of related cardiac issues or the use of medication for those health problems.

These results didn't stop proponents of expanding Medicaid from spinning the study. Grasping at straws, they said Medicaid recipients used more health-care services — never mind that doing so did little to improve health outcomes.

Put bluntly, Medicaid expansion makes its recipients feel better, even if they aren't receiving better medical care. In that way, the federal health law lives up to its name — it may be affordable care, but it is not effective care. All while new programs are being developed as healthy alternatives to Medicaid expansion like a successful pilot program that should be expanded.

Under the program, with an approach that supporters call CURE, patients have the power to choose among private plans and change their plans for any reason. CURE provides patients with financial incentives for healthy behavior and saves $118 million per year over the traditional Medicaid program, according to the Foundation for Government Accountability, a Florida public-policy organization that promotes limited government.

CURE also gives patients choices that lead to higher satisfaction with their coverage. Expanding this approach is a better option than expanding Medicaid in Florida...."

Column supports Florida lawmakers in rejecting Medicaid expansion - Orlando Sentinel (http://articles.orlandosentinel.com/2013-05-17/news/os-ed-florida-medicaid-expansion-con-20130516_1_new-medicaid-medicaid-expansion-federal-health-law)

[janmcn]

The problem with this thinking is the same problem going on in education. Once you accept that Federal money, you now have to adjust your budget accordingly. What happens next year or the year after when the Federal funds are no longer there? Now you have a budget shortfall that is even worse! Just look at Marion County School District.


Florida was slated to receive five billion a year for ten years for a total of over fifty billion dollars. These are not new federal taxes. These are federal tax dollars paid by the residents of Florida. Other states can say thank you Florida taxpayers.

[Dr Winston O Boogie jr]

Funny, I just opened another medical bill. This one is from a radiology company where I had some x-rays done.
The bill reads like this:
Xray Chest - 2 Views $88.00
Insurance Check $12.55
Insurance Write Off $60.45

Co Pay Due $15.00

The company gets $27.55 for a procedure that they charge $88.00 for. The reason that they charge $88 in the first place is that they know that the insurance companies are going to require a 69% discount. A person without insurance will pay $88.00.

I have been saying for years that this is a major factor in driving up the cost of health care and making it impossible for people without insurance to pay for. It's volume discounting run amok.

[Dr Winston O Boogie jr]

The problem with this thinking is the same problem going on in education. Once you accept that Federal money, you now have to adjust your budget accordingly. What happens next year or the year after when the Federal funds are no longer there? Now you have a budget shortfall that is even worse! Just look at Marion County School District.

Not only that, but you have to run your educational system according to the rules and regulations set up by the federal government. Some of these may not work in Florida. What works in Montana doesn't necessarily work in Florida.

It might be better if the federal government didn't take this money away from Florida in the first place. Let us keep our own money and deal with our own problems. I don;t think that a plane ride from Tallahassee to Washington DC makes a person all that much smarter.

[OhSuzannah]

I am a retired RN in North Carolina - hoping to move to TV soon. These problems are not unique to The Villages hospital. Basically the same thing is happening everywhere. I've worked in several large hospitals, and like most of you I've had family members in a number of hospitals as well. My best advice would be to avoid the ER almost at all costs. They are strictly for true emergencies. Unless you have potentially life threatening symptoms try to see your personal physician before you go to the ER. And, at lease phone his emergency/night/weekend phone number and report your problem if possible, before you go to the ER.

[rubicon]

I had an insuranc background (property/liability) however worked in Human Resoruces so was on the Life/health side too. I had a hate/love relationship witht eh fact that insureres got heavily involved in health isses in the 1980's (i.e second opinions, require authorizations for hospital stays, etc. some of it was good because of over use by both doctors and consumers and some of it interefered with medical best practices. the medical community adapted by uping their fees knowing cuts were coming.

To emphasis the point of overuse the only medicl area that could not be entire controlled was with those states that had No Fault Ins urance (PIP) flrodia, New York, New Jersey, etc. I can tell you factually some doctors, lawyers police officers, and their clients milk that system for all it was worth.

the Affordable Act is going to be all that is not good about our present system nd its going to be it on steroids. If you believe its bd now...just wait
Bottom line for me I wish the government and the insuranc ecompanies would let the market settle all of this.....but they won't lastly advances intchnology and the ability to extend life has also plenty of play here ....as does defensive medicine in order to avoid being sued or more to the pointthe fear that the docotr will lose a suit and his/her reputation especially if it is against a creative attorney like John Edwards of North Carolina who drove more doctors out of the state over his histronics in the court room

[justjim]

Florida was slated to receive five billion a year for ten years for a total of over fifty billion dollars. These are not new federal taxes. These are federal tax dollars paid by the residents of Florida. Other states can say thank you Florida taxpayers.

Florida turned down billions for high speed rail too. I'm not "smart" enough to know if this is good or bad---only time will tell. Since anything that might be political is not allowed discussion on TOTV, that's all I have to say about that!

[Mack184]

Agree Mack.

Why not share where your wife found a better deal. I'm not married to any place. At least you could send a PM with the details. Thanks.
PM sent your way....

[Mack184]

I am not challenging you, but I have to ask, how can a hospital meet a financial deficit? When the financial climate was tough in industry and the bottom line couldn't be met, hours got cut and people lost some perks and some people were let go.

You can't continue in the red indefinitely. It is obviously NOT an easy solution and something has got to give. Or SOMETHING needs to be refigured. I wish that the cost of charges for any hospital services were the same for the uninsured as they are for the insurance companies...to begin with and that medications were not so extravagantly expensive, although I know the cost of developing medicine is astronomical.

I can wish too. Not an easy answer at all it seems.
G-Person..you're not asking a wrong question. There are no easy answers. However, let's assume for a minute that there was nothing else that TVRH could do. (I don't believe that for a minute) By cutting all of these incentives away from the professional staff, the hospital is left with choosing from people who essentially can't get a better deal anywhere else. That doesn't bode well for the hospital in general.

There are a set of problems that challenge the hospital that are unique to TVRH. We've talked about lack of beds, lack of an increasing revenue stream and lack of staff. Now, many of the kind of professional people you might want on staff can't live here. If you've got a sharp nurse or other medical professional in their upper-30's or early 40's who would be an asset to the hospital, where will they live? They'll have to commute. So if the hospital is going to pay poorly, why commute and have the fuel expense and travel time? In today's world it doesn't make any sense.

In the letter the hospital administration sent out, there wasn't a peep about consolidating multiple management levels, looking for savings in purchasing or service contracts or other areas of cost savings, only cutting professional incentives.

The vast amount of complaints on this board about the hospital is how slow everything moves. So if you cut the pay of the people who you're counting on to keep things moving, why in the world would they want to work harder for less money..AND..commute?

The letter sent out by the hospital does not sound like a comprehensive plan. It sounds like this was the EASIEST thing they could do. Bad for their staff and bad for their community.

[Mack184]

These cuts at the local hospitals might not have happened if the Florida Legislature had not just rejected 55 billion federal dollars to expand Medicaid over ten years.
More Medi-CAID dollars will not help TVRH one scintilla. The bulk of their income is from Medi-CARE. Medi-CAID revenue at TVRH is so small as to be irrelevant.

[janmcn]

More Medi-CAID dollars will not help TVRH one scintilla. The bulk of their income is from Medi-CARE. Medi-CAID revenue at TVRH is so small as to be irrelevant.


The Medicaid expansion called for under the Affordable Care Act would insure close to one million uninsured Floridians. Anyone earning 150% of the poverty rate would be eligible. This would probably apply to most of the employees of The Villages, plus most of the waitstaff and other service personnel.

Five billion federal dollars injected into the health care system in Florida would be better than having close to one million uninsured Floridians show up at the emergency rooms across the state and receive free health care. If hospitals didn't have to eat this loss, perhaps more jobs and benefits could be saved.

BTW: not to get too political, but the governor, the state senate, all hospitals, the chamber of commerce, and others all supported this expansion.

[ilovetv]

Is a $2,000 Deductible 'Affordable'?

NEW YORK (CNNMoney)

Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges. But what will enrollees actually get for that monthly charge?

States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures:

$2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs.

Those are just some of the charges enrollees will incur in a silver-level plan in California, which recently unveiled an overview of the benefits and charges associated with its exchange. That's on top of the $321 average monthly premium.

Obamacare: Is a $2,000 deductible 'affordable?' - Jun. 13, 2013 (http://money.cnn.com/2013/06/13/news/economy/obamacare-affordable/index.html?iid=HP_LN)

[CFrance]

What is the cost for other states? And what is the cost for pre-existing condition insurance? Before Affordable Health Care Act, I was paying $368 in Michigan for a policy with a $7000 (yes, $7000) deductible due to a pre-existing condition. For a $2000 deductible, the cost would have been close to $1000.

[buzzy]

Management doesn't cut management.

[jbdlfan]

Florida was slated to receive five billion a year for ten years for a total of over fifty billion dollars. These are not new federal taxes. These are federal tax dollars paid by the residents of Florida. Other states can say thank you Florida taxpayers.

I'm not talking about taxes. When you accept Federal money to fill a budget gap, that money better continue to flow into your budget at the same rate or you will have a problem. Simple math, if I have a 10 dollar budget and I have five dollars of income, I have two choices: shrink my budget or increase revenue. If I increase my revenue and not cut my budget, I better be sure that revenue continues or I'm just prolonging the pain. This is exactly what happened in Marion County. Only there, the federal government shut off the spigot!

[2-crazy]

First let me say I am a strong advocate for Universal Care. The structure of the healthcare system is invalid for we pay only for services delivered regardless of true benefits for the patient. We see the doctors to often with unnecessary care in the US.
Time Magazine recently had an article on our healthcare system and the ‘charge masters’ which is a comprehensive lists of charges for everything (e.g.gauze pads, aspirins, saline solutions etc.) for hospitals use throughout the country.

At many establishments there is ‘circle the wagons’ mentality but some are taking a comprehensive review of the impacts on programs to reduce healthcare coats and improving health outcomes. The Affordable Care Act is here and we must deal with it. Here in The Villages they are implementing Village Health Care Centers (one currently at Colony) others soon to be opening that will hopefully look more at preventive measures of health (pro-active) which will lower the cost of healthcare and be more beneficial to all of us.

[Russ_Boston]

PM sent your way....

Thanks - I was unable to respond because you have your PM receive off. Thanks for the data though.

Russ

[upstate]

A new hospital was opened in my area two years ago, consolidating two others that had been around for the decades. It has less beds than the other two combined and was going to be a Level 2 Trauma Center. Still waiting for the Trauma Center and staff layoffs began three weeks ago. I asked why less beds when at times EMS had to be placed on divert, my answer was the state determines the amount of beds to be placed. This is going to become a nationwide problem.

[upstate]

A new hospital was opened in my area two years ago, consolidating two others that had been around for the decades. It has less beds than the other two combined and was going to be a Level 2 Trauma Center. Still waiting for the Trauma Center and staff layoffs began three weeks ago. I asked why less beds when at times EMS had to be placed on divert, my answer was the state determines the amount of beds to be placed. This is going to become a nationwide problem.

[blueash]

What is the cost for other states? And what is the cost for pre-existing condition insurance? Before Affordable Health Care Act, I was paying $368 in Michigan for a policy with a $7000 (yes, $7000) deductible due to a pre-existing condition. For a $2000 deductible, the cost would have been close to $1000.

Had you gone with the 2000 deductible instead of the 7000 deductible it would put the insurance company at risk for 5000/yr. And to cover you for that 5K they are charging you an additional how much? Using 950 as your "close to 1000" it would be 950 - 368 or 582 more dollars per month times 12 months for a bill of 6984 dollars to cover 5000 in risk. Of course some years you might not have 7000 in charges so the real risk is even lower than 5000. I'd love to own a business where you pay me 6984 and then I might have to give you 5000 maximum if things go badly for you.

[CFrance]

Had you gone with the 2000 deductible instead of the 7000 deductible it would put the insurance company at risk for 5000/yr. And to cover you for that 5K they are charging you an additional how much? Using 950 as your "close to 1000" it would be 950 - 368 or 582 more dollars per month times 12 months for a bill of 6984 dollars to cover 5000 in risk. Of course some years you might not have 7000 in charges so the real risk is even lower than 5000. I'd love to own a business where you pay me 6984 and then I might have to give you 5000 maximum if things go badly for you.

What they covered after that $7000 was d*** little, and my pre-existing condition was at small risk of returning. So I think they made out like bandits. I have little sympathy for medical insurance companies. Why aren't they going after the hospitals who charge $6800 for a colonoscopy when other first-world countries charge $1500, instead of taking it out on their customers?

Our son tore his ACL in college in Maine, and because he wanted to have it fixed in MI so he could recuperate at home with us, the hospital here charged him $30,000 for the operation because he was "out of network" for his Maine insurance. If he hadn't injured himself in a school-sanctioned sport, he would have been liable. What kind of a rip-off is that?

[Suzi]

This is very scary. I think the bottom line in health care today is money. While there may be caring medical staff, it all comes down to revenue and I don't think that they really care if we live or die as long as they can make a profit. That's just how I look at health care today. I hope I continue to stay healthy!

There are less and less hospitals that are independant. Meaning that most are now owned by corporations, hedge-funds and investment entities. Business now runs almost all hospitals and clinics. Business people care about the bottom line. Don't mix up the compassion of nurses and doctors to the business ethic of making money. Most if not all of the corporations who own these hospitals don't even have a doctor on their boards.