[wendyquat]

Originally Posted by 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.

[Mack184]

Originally Posted by 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.

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]

Originally Posted by Mack184

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]

Originally Posted by Mack184

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]

Originally Posted by The Buckeyes

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]

Originally Posted by Mack184

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]

Originally Posted by 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.

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]

Originally Posted by 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.

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

[janmcn]

Originally Posted by jbdlfan

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]

Originally Posted by jbdlfan

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