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

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.

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!

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.

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.

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.

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!

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.

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.

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>

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.

Very disturbing!

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.

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!

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

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.

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.

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!!

Money, money, money....
 

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!

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.

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!

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.

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.

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

:agree:

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.

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.

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.

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.

Interesting
 

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.

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.

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