Over half of Mississippi's rural hospitals risk closing

[Boom Boom]

I’ve already said Expansion would help, but expansion would not produce the consistent volume needed to keep the rural hospitals afloat as they currently operate

Maybe, maybe not. If it did fall short, probably not hard to pass a fix through Congress. But impossible to if states aren't taking the Medicaid money to start with. Now, it's a mess of our own making, other states have no interest in spending their tax money to fix it. Nor should they.

 

[Boom Boom]

The other problem with Medicaid expansion is how much do you want to pay in taxes. After a certain amount of years, the Feds pass on increasing amounts to the state to cover. Eventually it would cost the state billions. And you are the one to pay that. That's why all these free lunch deals sound great, until you read the fine print. Are you interested in paying 5 to 10k more a year in taxes. I'm not

No. The ACA provided for 100% of the costs for 2014 to 2016, dropping to 90% after 2016 in perpetuity. The covid stimulus bills added a sweetener above that for non-expansion states that chose to expand, for several years. But at no point does it drop below 90%. And as we see, MS one way or another will have to spend money on this. Might as well be taking a 90cent on the dollar discount on that, dontcha think?

 

[johnson86-1]

The AMA is the best labor union ever created.

And as ruthless. Maybe not any more ruthless than the old school unions that were racist and beat scabs and engaged in essentially terrorism, but still pretty gangsta to take the position that it’s better for poor people to get no care at all than to get to see a nurse without a doctor getting his or her cut.

 

[johnson86-1]

Maybe, maybe not. If it did fall short, probably not hard to pass a fix through Congress. But impossible to if states aren't taking the Medicaid money to start with. Now, it's a mess of our own making, other states have no interest in spending their tax money to fix it. Nor should they.

Obamacare drafters wanted rural hospitals to turn into triage centers with limited capabilities beyond stabilizing patients enough to transfer them. They thought having more or less full service hospitals in rural areas was wasteful and that DSH payments propped up this wastefulness.

Politics are different now, and of course most voters and even a lot of legislators that voted for Obamacare didn’t understand what all it intended to do, so it might could be changed, but it’s acting as intended. Poor management combined with lack of Medicaid expansion is probably going to result in GL hospital closing rather than the intended plan of it turning into a triage center for ummc like Hancock county hospital has become for Ochsners. .

 

[paindonthurt]

Over half of Mississippi's rural hospitals risk closing

Mississippi's leading public health official says over half of the state's rural hospitals are at risk of closing immediately or in the near future

abcnews.go.com

54% of rural hospitals in the state are at risk for closure? That is heartbreaking and concerning.
Here, 24% of rural hospitals are at risk and one closed last month. That hospital system said it will instead focus on outpatient and specialty care at small clinics.

How many are privately owned vs what och is?

 

[L4Dawg]

The AMA is the best labor union ever created.

Most Doctors are not members of the AMA.

 

[L4Dawg]

Obamacare drafters wanted rural hospitals to turn into triage centers with limited capabilities beyond stabilizing patients enough to transfer them. They thought having more or less full service hospitals in rural areas was wasteful and that DSH payments propped up this wastefulness.

Politics are different now, and of course most voters and even a lot of legislators that voted for Obamacare didn’t understand what all it intended to do, so it might could be changed, but it’s acting as intended. Poor management combined with lack of Medicaid expansion is probably going to result in GL hospital closing rather than the intended plan of it turning into a triage center for ummc like Hancock county hospital has become for Ochsners. .

Yep, that was exactly what they wanted. They wanted to force everything into big systems. It was designed basically to create an Americanized version of the British NHS. Like most powerful liberals they had/have no knowledge of or experience with rural America. Throw that in with a profound misunderstand of and disdain for business, especially the business side of healthcare, and it's the perfect recipe for disaster. Rual healthcare was already in trouble, tha ACA poured fuel on what was a smoldering fire.

 

[PooPopsBaldHead]

There's a great website with all of the real facts and solutions about this situation if anyone cares to read about it rather than bicker with half truths and unknowns. There's even a sortable database that you can use to see the rural and urban data in hospitals in a state along with its respective revenue, margins from patient services and total margins.

Saving Rural Hospitals

Some key things I learned in an hour of reading that site vs the experts of SPS.

Medicaid expansion helps a little but not a lot as for most rural hospitals in the US there are more private payers in rural areas that Medicaid and Medicare. Though in Mississippi there are areas like the Delta with higher concentrations of patients that would utilize Medicare expansion than most rural areas. The offset of having more people insured vs the lower payments from Medicare is negligible.

Many rural hospitals are identified as critical and actually get paid more from Medicare than private insurance.

Medicare Advantage sucks. It pays considerably less than Medicare.

Many rural hospitals are even losing their asses in private insurance because it pays rates that work for urban hospitals that have economies of scale. It just costs more relative to revenue to run a rural hospital. IE an emergency room in Jackson and Noxapater are both staffed 24/7. The Jackson ER is constantly generating revenue and Noxapater might go days without a patient.

The 2 big revenue buckets are patient services and "other". Patient services are all the incomes from treatment whether it's paid by Medicare, private insurance, out of pocket, or just goes unpaid. Other is basically income from investments, the cafeteria, but far and away, government funding from taxpayers.

Lots of rural hospitals are underwater on patient services, but make up for it in the "other" category. One mind blowing example of this is the 2 biggest hospitals in MS. UMMC and NMMC. UMMC loses it's *** and then makes it all up and then some on other funding (which includes tuition and taxpayer funds.) NMMC makes a 7% margin on patients and that's their total margin. St. Dominick's in Jackson doesn't have that other funding and is underwater.



The current fix is to increase local public funding of rural hospitals. Mississippi pays very little tax towards hospitals comparatively. This will "save" a lot of these rural hospitals, but the long-term solution is to get all payers (private and federal insurance) to recognize that you have to pay more for rural services. In the overall scheme fixing this will cost the healthcare system less than 1% of current costs. That's likely to pay itself back by ever so slightly reducing the cost of crops, timber, and other necessities made in rural America that currently face disproportionately higher healthcare costs.

 

[Podgy]

Most Doctors are not members of the AMA.

But they benefit from it even though they might complain about some of its ideological positions.

 

[The Cooterpoot]

The drug and insurance industries drive medical costs. Our government sucks them off.

 

[L4Dawg]

The people I know in healthcare administration say that Medicare doesn't reimburse at a profitable rate. It may not cause losses, but it's not going to make up for any either. Most of them say it's a small loss. Medicaid is another story.

 

[Boom Boom]

Obamacare drafters wanted rural hospitals to turn into triage centers with limited capabilities beyond stabilizing patients enough to transfer them. They thought having more or less full service hospitals in rural areas was wasteful and that DSH payments propped up this wastefulness.

Politics are different now, and of course most voters and even a lot of legislators that voted for Obamacare didn’t understand what all it intended to do, so it might could be changed, but it’s acting as intended. Poor management combined with lack of Medicaid expansion is probably going to result in GL hospital closing rather than the intended plan of it turning into a triage center for ummc like Hancock county hospital has become for Ochsners. .

Maybe, there's plenty of logic in such a plan, but I've never heard that, and you have a terrible track record with such proclamations.
Also, kinda contradictory to say in the same breath that ACA legislators didn't know what they were passing in the bill, but had a secret plan to it as well.

 

[Boom Boom]

The people I know in healthcare administration say that Medicare doesn't reimburse at a profitable rate. It may not cause losses, but it's not going to make up for any either. Most of them say it's a small loss. Medicaid is another story.

Of course they say this, but it's almost certainly untrue. Ie, it doesn't pay enough to cover outrageous top salaries and waste like private care does, but it most certainly pays for more than the cost.

Ironic that this is what cons claim they want govt to be, but hate it when they have it.

 

[horshack.sixpack]

The other problem with Medicaid expansion is how much do you want to pay in taxes. After a certain amount of years, the Feds pass on increasing amounts to the state to cover. Eventually it would cost the state billions. And you are the one to pay that. That's why all these free lunch deals sound great, until you read the fine print. Are you interested in paying 5 to 10k more a year in taxes. I'm not

if only there were something written in the Bible to help these “Christian” leaders know if they were expected to make personal sacrifices for the benefit of those that aren’t as fortunate…

 

[Rupert Jenkins]

You pay for it out of your taxes whether it's state or federal. Maybe we need less people suckling at the Gov't teet. Of course another way of approaching it would be saying hospitals could try cutting costs. And of course it's not the governor making sacrifices. His extra taxes don't hit quite as hard. Let's let the guy barely scrubbing by on 60k a year pay for the morbidly obese woman's diabetic treatments along with her $800 a month worth of food stamps.

 

[L4Dawg]

But they benefit from it even though they might complain about some of its ideological positions.

No, they actively work against the interests of the majority of physicians.

 

[L4Dawg]

Of course they say this, but it's almost certainly untrue. Ie, it doesn't pay enough to cover outrageous top salaries and waste like private care does, but it most certainly pays for more than the cost.

Ironic that this is what cons claim they want govt to be, but hate it when they have it.

Lol, you haven't learned anything at all since the old days.

 

[Boom Boom]

I don't think you want to bring up the past, mandate-boy.

Same old Liver, dumbass personal attack rather than admit a point or have a good faith discussion. You are everything that's wrong with conservatives.

And I have learned. I've learned that people like you will never, ever do whats right if it involves swallowing some pride.

Lol, you haven't learned anything at all since the old days.

 

[L4Dawg]

I don't think you want to bring up the past, mandate-boy.

Same old Liver, dumbass personal attack rather than admit a point or have a good faith discussion. You are everything that's wrong with conservatives.

And I have learned. I've learned that people like you will never, ever do whats right if it involves swallowing some pride.

Nope, nothing at all. What we said was going to happen when ACA started to bite is happening just like we said. It's killing rual healthcare. Whether it was intentional or not it could not have been designed better to do that. It's also forcing all healthcare into giant NHS like cooperatives. I told you back when it passed that was what it was going to do.

 

[johnson86-1]

Maybe, there's plenty of logic in such a plan, but I've never heard that, and you have a terrible track record with such proclamations.
Also, kinda contradictory to say in the same breath that ACA legislators didn't know what they were passing in the bill, but had a secret plan to it as well.

Drafters does not equal legislators unfortunately.

 

[johnson86-1]

The drug and insurance industries drive medical costs. Our government sucks them off.

Insurance companies do not drive costs. If it was up to them, doctors wouldn’t be rich. We subsidize demand and restrict supply. That shockingly drives costs up.
We also just about mandated consolidation as a federal policy which further limits insurance companies ability to restrain costs.

 

[L4Dawg]

Insurance companies do not drive costs. If it was up to them, doctors wouldn’t be rich. We subsidize demand and restrict supply. That shockingly drives costs up.
We also just about mandated consolidation as a federal policy which further limits insurance companies ability to restrain costs.

The federal government effectively sets healthcare reimbursement rates. Look it up.

 

[johnson86-1]

The people I know in healthcare administration say that Medicare doesn't reimburse at a profitable rate. It may not cause losses, but it's not going to make up for any either. Most of them say it's a small loss. Medicaid is another story.

That’s fake. If a hospital has a good patient mix, Medicare is going to reimburse around average cost of care but well above marginal cost. But both of those terms mean less when the cost of care is driven by how much a cartel can squeeze out.
Even excluding that issue, hospitals invest in facilities based on what their community can support. So even in the facilities side, the “doesn’t pay cost” is misleading. They don’t pay for facilities that were never built for them. They help cover costs by paying above marginal costs.

 

[L4Dawg]

That’s fake. If a hospital has a good patient mix, Medicare is going to reimburse around average cost of care but well above marginal cost. But both of those terms mean less when the cost of care is driven by how much a cartel can squeeze out.
Even excluding that issue, hospitals invest in facilities based on what their community can support. So even in the facilities side, the “doesn’t pay cost” is misleading. They don’t pay for facilities that were never built for them. They help cover costs by paying above marginal costs.

Well, the main one was just the CEO of the largest system in one of the largest cities in the country. Probably didn't know nuthin.

 

[Boom Boom]

Its Liver. If you expect him to admit an error, you are mistaken.

That’s fake. If a hospital has a good patient mix, Medicare is going to reimburse around average cost of care but well above marginal cost. But both of those terms mean less when the cost of care is driven by how much a cartel can squeeze out.
Even excluding that issue, hospitals invest in facilities based on what their community can support. So even in the facilities side, the “doesn’t pay cost” is misleading. They don’t pay for facilities that were never built for them. They help cover costs by paying above marginal costs.

 

[Boom Boom]

Nope, nothing at all. What we said was going to happen when ACA started to bite is happening just like we said. It's killing rual healthcare. Whether it was intentional or not it could not have been designed better to do that. It's also forcing all healthcare into giant NHS like cooperatives. I told you back when it passed that was what it was going to do.

Ok, Joe Montegna.

Meanwhile, rural health care in states that expanded Medicaid is doing just fine. How strange. You will always be a clown, Liver.

https://www.cbpp.org/research/health/affordable-care-acts-medicaid-expansion-benefits-hospitals-particularly-in-rural

 

[Boom Boom]

Drafters does not equal legislators unfortunately.

When it comes to Congress, they do. The WH or whoever can draw up whatever bill they want, but the legislative drafters change it to whatever they want. The only real drafters of Congressional bills are legislators (or their aides/staff).

Besides, if you remember your history, Obama left the pre-drafting of ACA to Congress, after Hillary's pre-drafting of Clinton care drove away votes. So, wrong on all counts. Not that that ever matters to you two.

 

[Nicephorus123]

The uncomfortable truth of rural hospitals in Mississippi is they can delay definitive treatment or care especially in very sick patients due to lack of specialists and procedure coverage. Many of these places only provide the most basic medical services. Seen several patients over the years admitted to smaller hospitals that do not receive what would be “standard of care” at a larger facility due to lack of specialists and procedure availability. Many of these patients would receive substantially better care had they drove another hour or so down the road to get to their belly pain evaluated at an ER at a larger facility. Medical transfers, especially once a patient has been admitted from the ER, can take some time to arrange.

As medicine becomes more high tech and specialized, it is becoming very difficult for smaller hospitals to keep up.

 

[MSUGUY]

Most Doctors are not members of the AMA.

Very true

 

[L4Dawg]

Ok, Joe Montegna.

Meanwhile, rural health care in states that expanded Medicaid is doing just fine. How strange. You will always be a clown, Liver.

https://www.cbpp.org/research/health/affordable-care-acts-medicaid-expansion-benefits-hospitals-particularly-in-rural

No it's not.

 

[tribaldawg]

Goodness. That doesn’t even deserve a response.

He is 100% correct. I see it every single day firsthand.

 

[MSUGUY]

There's a great website with all of the real facts and solutions about this situation if anyone cares to read about it rather than bicker with half truths and unknowns. There's even a sortable database that you can use to see the rural and urban data in hospitals in a state along with its respective revenue, margins from patient services and total margins.

Saving Rural Hospitals

Some key things I learned in an hour of reading that site vs the experts of SPS.

Medicaid expansion helps a little but not a lot as for most rural hospitals in the US there are more private payers in rural areas that Medicaid and Medicare. Though in Mississippi there are areas like the Delta with higher concentrations of patients that would utilize Medicare expansion than most rural areas. The offset of having more people insured vs the lower payments from Medicare is negligible.

Many rural hospitals are identified as critical and actually get paid more from Medicare than private insurance.

Medicare Advantage sucks. It pays considerably less than Medicare.

Many rural hospitals are even losing their asses in private insurance because it pays rates that work for urban hospitals that have economies of scale. It just costs more relative to revenue to run a rural hospital. IE an emergency room in Jackson and Noxapater are both staffed 24/7. The Jackson ER is constantly generating revenue and Noxapater might go days without a patient.

The 2 big revenue buckets are patient services and "other". Patient services are all the incomes from treatment whether it's paid by Medicare, private insurance, out of pocket, or just goes unpaid. Other is basically income from investments, the cafeteria, but far and away, government funding from taxpayers.

Lots of rural hospitals are underwater on patient services, but make up for it in the "other" category. One mind blowing example of this is the 2 biggest hospitals in MS. UMMC and NMMC. UMMC loses it's *** and then makes it all up and then some on other funding (which includes tuition and taxpayer funds.) NMMC makes a 7% margin on patients and that's their total margin. St. Dominick's in Jackson doesn't have that other funding and is underwater.

View attachment 267236

The current fix is to increase local public funding of rural hospitals. Mississippi pays very little tax towards hospitals comparatively. This will "save" a lot of these rural hospitals, but the long-term solution is to get all payers (private and federal insurance) to recognize that you have to pay more for rural services. In the overall scheme fixing this will cost the healthcare system less than 1% of current costs. That's likely to pay itself back by ever so slightly reducing the cost of crops, timber, and other necessities made in rural America that currently face disproportionately higher healthcare costs.

View attachment 267238

View attachment 267241

View attachment 267242

There's a great website with all of the real facts and solutions about this situation if anyone cares to read about it rather than bicker with half truths and unknowns. There's even a sortable database that you can use to see the rural and urban data in hospitals in a state along with its respective revenue, margins from patient services and total margins.

Saving Rural Hospitals

Some key things I learned in an hour of reading that site vs the experts of SPS.

Medicaid expansion helps a little but not a lot as for most rural hospitals in the US there are more private payers in rural areas that Medicaid and Medicare. Though in Mississippi there are areas like the Delta with higher concentrations of patients that would utilize Medicare expansion than most rural areas. The offset of having more people insured vs the lower payments from Medicare is negligible.

Many rural hospitals are identified as critical and actually get paid more from Medicare than private insurance.

Medicare Advantage sucks. It pays considerably less than Medicare.

Many rural hospitals are even losing their asses in private insurance because it pays rates that work for urban hospitals that have economies of scale. It just costs more relative to revenue to run a rural hospital. IE an emergency room in Jackson and Noxapater are both staffed 24/7. The Jackson ER is constantly generating revenue and Noxapater might go days without a patient.

The 2 big revenue buckets are patient services and "other". Patient services are all the incomes from treatment whether it's paid by Medicare, private insurance, out of pocket, or just goes unpaid. Other is basically income from investments, the cafeteria, but far and away, government funding from taxpayers.

Lots of rural hospitals are underwater on patient services, but make up for it in the "other" category. One mind blowing example of this is the 2 biggest hospitals in MS. UMMC and NMMC. UMMC loses it's *** and then makes it all up and then some on other funding (which includes tuition and taxpayer funds.) NMMC makes a 7% margin on patients and that's their total margin. St. Dominick's in Jackson doesn't have that other funding and is underwater.

View attachment 267236

The current fix is to increase local public funding of rural hospitals. Mississippi pays very little tax towards hospitals comparatively. This will "save" a lot of these rural hospitals, but the long-term solution is to get all payers (private and federal insurance) to recognize that you have to pay more for rural services. In the overall scheme fixing this will cost the healthcare system less than 1% of current costs. That's likely to pay itself back by ever so slightly reducing the cost of crops, timber, and other necessities made in rural America that currently face disproportionately higher healthcare costs.

View attachment 267238

View attachment 267241

View attachment 267242

That’s a lot of information, it’s complicated. As was initially stated Medicaid expansion is a small slice of the solution.
As you pointed out, the critical access facilities do very well , just look at Ruleville. Patient drive from Cleveland (where there’s big Bolivar Medical Center) to Ruleville to get Healthcare. Why?, because the doctors and therapists are flocking to the Ruleville where Medicare pays130% above its standard allowable.

It’s simple, Medicare and Medicaid don’t reimburse fairly and neither does BCBS per your information.

BCBS/UHC have record profits, not our hospitals!