Dave, I work for a non-profit hospital*and we NEVER turn ANYONE away. If the cops pick up a lifetime alcoholic in the ditch and send him to us he spends 10 days in intensive care, another 2-3 days in a step down unit, and another 60 days in a regular hospital room because we can't discharge him/her to the streets and no one will accept the dude until medicare/medicaid is in place (the social workers at the hospital take care of this process too). EVERYONE gets the same level of care regardless of ability to pay. For all this service we get absolutely NOTHING! And then the dude walks away from the resident care facility, gets lit up again and it starts all over. This happens all the time. And don't forget the poor freakin' souls who are mentally ill and have been forced from institutional living to the community mental health model. No longer in a mental hospital (there virtually are none left in the US) they are forced to live in the community. When this fails guess where they go. Yup to us. We were 103 days waiting for a spot to open up in one of the two public mental health facilities in the state appropriate for a recent patient. We MIGHT be able to recover some of this cost. At least some of it.Operating profit fy 2011 was $112 million on revenue of $1.638 billion. Operating profit fy2012 was $12million. Not much of a profit especially considering the unknown costs of obamacare etc. We aint getting rich. We write off literally 100's of $ millions each year for indigent services. It's the right thing to do. These people should have access to healthcare so they get it regardless of their ability to pay.
Another issue that may not be well known is that compensation for an illness/procedure is dictated by the insurance companies or medicare/medicaid XYZ illness allows only X number of days. These lengths of stay are short. Very short. If the patient is not ready to go home then the hospital eats the cost for the extended stay. Someone gets a UTI from a catheter? We pay for it. This is reasonable but still expensive. If some poor confused person gets up in the middle of the night with no family member to stay with them, and the staff is not able to answer the bed exit alarm and get to the patient before they fall? Oh yeah. CT scan, xrays for the fractured hip, surgery and appliance for the hip replacement at $100k+ and we get to eat this one too. If the patient is released and returns to the hospital within 30 days we pay for the total cost of this stay too.
As far as the insurance companies paying whatever the hospital bills? Go back and pull the sheets that explain the payment to the hospital. Not even close to paying the amount billed.
The cost of small items? Take a Vicoden (5 mg hydrocodone, 500 mg acetaminophen). Cost at the pharmacy on the corner? Probably $1.50. At the hospital? Probably $25.00. The pharmacist is the only one at a pharmacy who gets paid any money. $65K - $120K. The hospital has Pharmacists who make more money because of their additionally required credentials. We are also, obviously, required to have pharmacists on duty 24X7. The hospital then purchases and pays for the med in large quantities, store it until needed, send a technician to fill the Pyxis (the machine that controls medication dispensing on each hospital unit, pay the nurse to make sure the order is correct FOR EACH MEDICATION FOR EACH PATIENT EVERY TIME, dispense the medication to the patient, and chart the information. The Pyxis is an EXPENSIVE piece of equipment. So are the computer systems, scanners and software used to make the dispensing of the med to the patient as safe as possible. Right med, right patient, right strength, right dose, right route, right time, etc. It costs a lot of money to manage that one single med.
By the way, the nurses and the doctors aren't getting rich either. If you want to make good coin as a physician you had better be a surgeon. Eyes are good, cardiovascular is better, neurology is even better yet.
I wish we were getting rich but we aren't. Maybe next year. Sorry for the RIDICULOUSLY long post but it is nice to be able to get the word out from a different perspective from someone who lives it.
Originally Posted by dshealey
I do not see it as inefficent at all. Everything I have had to have done has been done quickly, and in my opinion very well.
The problem with it being the most expensive is the one that is the BIG problem! We let greed be the driving force. When the same procedures are done in other countries for a fraction of what they cost here, and the same exact drugs cost a fraction of what they do here, that is the massive problem we have.
The cost of even small items in an itemized hospital bill is mind boggling.
I see the problem as being caused by the insurance companies just paying the bills, and not fighting for reasonable charges, then the rates go up to pay for it.