Texas Hospital Merger Cancellation is a Good Thing

The patient tower at CHI St Francis in Grand Island (NTV News)

New Orleans       Hospitals are having some problems these days.  The Republican attacks on the Affordable Care Act meant that fewer of the uninsured that desperately needed health care can find – or finance – their way into hospital beds.  At the same time ACA and the attention during the health care debates did lead to some increased scrutiny about bill-padding and other concerns.  Local 100 United Labor Unions and ACORN International also paid close attention to the requirements in the ACA introduced by Iowa’s Republican Senator Charles Grassley of all people that focused on the number of hospitals that enjoyed tax-exempt nonprofit status but were the opposite of charitable.  With the help of interns from Tulane University and the University of Ottawa, our research into the IRS 990s of the nonprofit hospitals in Texas, Arkansas, and Louisiana found that many institutions were miserly despite their status.

All of which brings us to Houston’s giant nonprofit Memorial Hermann and Dallas’s huge Baylor Scott & White nonprofit chain.  Neither of which were really responsive to our requests for meetings, despite the requirements under the Act that they accept community input.  Nor were they willing to meet about their under-par charitable giving.  Their announcement last fall that they were entering discussions to merge, seem to us a step towards making a bad thing worse.  We took their announcement that the merger was off as good news.  A merger might have made them unassailable, so now when they remain separate, they will simply continue to be unaccountable.

These are big boys among hospitals nationally, not just in Texas.  “Baylor Scott & White had $582 million in operating income on revenue of $9.5 billion, according to financial disclosures to bond investors. Memorial Hermann closed the fiscal year with operating income of $129 million and revenue of $5.3 billion,” as reported by the Wall Street Journal.  If the merger had been consummated, they would have been even larger.  To the hometown paper, The Houston Chronicle, Memorial Hermann was as close-mouthed as they were with us about their charity care, issuing a statement full of platitudes.  Sources elsewhere claim the discussions went south when Memorial Hermann balked at the level of cutbacks in operations.  Who knows?  Who cares?

For all the talk about consolidation in health care being a good thing and supposedly delivering economies of scale, none of us have seen that happening in reality as health care costs continue to increase across the board.  Another word for such combinations is monopoly, and that’s not good for any of us.

The Federal Trade Commission should be all over these attempts to corner markets in hospital care, but they seem asleep at the switch in healthcare, just as they have been in supervising tech for example.  This merger may have caved under its own weight, but others have been completed around the country, and no one seems to be jumping in front of this train.

We’re not the only ones that are worried, either.  Reporting on these mergers, here’s a quote from the Wall Street Journal:

Dignity Health and Catholic Health Initiatives closed a merger last month to create the 142-hospital CommonSpirit Health. Last year, Aurora Health Care and Advocate Health Care formed a regional giant spanning Illinois and Wisconsin and Bon Secours Health System Inc. in Marriottsville, Md., merged with Mercy Health in Cincinnati.  One downside of the consolidation is it has given some large systems the size to raise prices and stymie efforts to reduce health-care spending. The deals can also result in patients being steered to specialists inside the systems, even if an outside referral might provide greater benefit.

See what I’m saying.  Just because they are claiming tax-exemptions, don’t make the mistake of believing they aren’t all about the dollar.

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Please enjoy Existential Frontiers by White Owl Red.

Kim Lenz’s Bury Me Deep.

Thanks to KABF.

 

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Hospital Accountability on Pricing and Personal Medical Records

New Orleans   Just because a big piece of the government is shutdown and a lot of stuff at the top of the heap has been totally cray-cray doesn’t mean that there is no good news to be found anywhere at the federal level.  Maybe it takes a bit of searching, but even with the attack on the Affordable Care Act, we seem to all still believe that healthcare institutions require some accountability.

For example, as of January 1st, 2019, all hospitals in the country are required to post a list of their standard charges for all of their services as well as for the drugs and tests they provide.  Furthermore, they are required by the federal government to post these charges in a way that you can download them on your computer at home and review them, even before you are under the knife or undergoing some treatment.

There are a couple of caveats of course.  One is the reminder that the charges hospital’s list may not be the real cost to the consumer’s pocketbook.  Insurance payments would impact that as well, but at least you will know the retail or sticker price that they are trying to get for a band aid, a transplant, or a new baby.

The other warning is that they are posting this on their websites.  Anyone who has ever been on their local hospital’s websites, knows that this gives them additional pains in several well-regarded body parts.  Additionally, it goes without saying that you would need internet and computer-style access in order to do the download, and many of the families that need this information the most are also numbered in the huge masses in our cities and rural areas that lack such access.

Another part of this new federal rule taking effect now is supposed to make your electronic medical records available to you.  The same problems exist there, but it’s still a good rule.  The government has spent billions helping hospitals make their information and records digital and available.

I’m skeptical whether many of these institutions are ready for prime time and the turn of the calendar.  I had occasion to need to make an appointment at my billion-dollar local nonprofit hospital, Ochsner for example.  Calling them, you are harangued about going on your computer to quicken the process.  Doing so is a horror.  Over a half-hour I was kicked off the site four times and told a dozen times that the hospital’s server was not accepting communications about scheduling – or anything else.  I called them and got an appointment on the old school telephone blower within minutes.

Another bunch of emails instructs you to go on-line and fill out your medical and other history before you show up to speed the process.  Having just done that for my annual physical and still being forced to fill out the form, I wasn’t going to be fooled by those messages a second time.  Sure enough when I showed up, they tried to give me the form to fill out again.  I said I would only do it if they can show me that my history wasn’t already in the computer since I had filled it out online and on paper previously.  The nurse said, “well this is so that the doctor has it in front of them.”  I said, “the computer is in front of them.”  Anyway, she looked and nada.  My record on past illnesses and family history wasn’t there.

In recent months Atul Gawande, the Boston-based author and doctor, wrote an amazing article in The New Yorker questioning whether computerization was helping or hindering doctors after his hospital system, the famous Partners nonprofit, had spent a billion or so making everything electronic.  Doctors were spending more time on their computers than with their patients.

Their computers might have worked, and they actually had computers at home and at work.  Both of those things might be a couple of steps ahead of many of us, but this rule will definitely be a step forward once we can catch up to it, and if there are real penalties for hospitals not complying.

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