Very well written. Your illustrations of the PBM game and Pharma "gifts", the MLR ruse and overall GDP/national HC expenditures were very much on-point. I do understand clearly the illustration showed on Mayo Clinic's activities. However, as a seasoned operator of hospitals and health systems, I think attacking the CON as a villain of monopoly-building and price inflation should be tempered with the "why" there was the thought for the laws in the first place. If outpatient competition is(good) for communities wholesale, then how are disparities in access/availability/acuity and regulatory burden addressed now that DSH is eradicated? An example - a local outpatient imaging center opens up across the street from Hernia Memorial Hospital. It has (transparent) prices on outpatient CT, MRI and ultrasound procedures. Let's assume they are 15-20% lower cost to payors/customers than the comparable same examinations at HMH. Steerage from the BUCAHs will occur with lightening speed. So, the YOY OP revenue to HMH will start to wilt. Why is this a problem? It could be that the pricing/revenue differential covered some of the grossly underfunded maternity/critical ICU/ER/Behavioral care that this and most communities manage. We all know what living on CMS-based reimbursements alone does to the futures of hospitals, so I won't bore you. However, the vastly uneven legal (EMTALA), regulatory (State, CMS, etc.) and cost of services (OB, ER, ICU, Trauma) burden that MHM has to fund hour-by-hour needs some funding at a differential for sustainability. I have probably not done the example justice as I am not much of a writer. I only wanted to say that we will need something for whatever we as a country deem as essential services for our communities to be supported. So many more hospitals are just trying to fund their next nursing shift and only serve their local communities, not the UAE. Again, well done.
I really appreciate the thoughtful comment. And I agree with you. It's not that the spirit of CON laws are wrong, it's more how these are taken advantage of. Isn't that always the case? Large organizations find ways to leverage and influence laws to serve their own interests. Nonetheless, it's why wholesale reform across reimbursement models is so sorely needed. Thank you again for the amazing addition to the discussion.
Preston, this is awesome! I love your writing style and how easily you break down the nonsense complexity we're dealing with in American healthcare. Someday, I'd love to read your thoughts on what everyone seems to be clamoring for -- universal healthcare, medical for all, single payer, or whatever else people are calling it these days. For me, it's the idea that we throw our hands up and say, "we give up" and bend over and let the system have its way with us. I hate it when people say, "every other country in the world does healthcare like this except us". I really need to come up with a better reply but the only one I've come up with to date is "sure, plenty of other countries in the world slaughter their own people with machine guns and chemical weapons but I'm certainly not advocating we copy them on that either". I know, it's not a great comeback. I'm just not a "give up and let the other side win" kind of girl. Anyway, thank you for this great blog. I really like it.
I appreciate it! I do have thoughts on Universal healthcare. It takes a full redesign of the financial models. One day maybe I will have the time to really flesh it out and put numbers behind it.
Very well written. Your illustrations of the PBM game and Pharma "gifts", the MLR ruse and overall GDP/national HC expenditures were very much on-point. I do understand clearly the illustration showed on Mayo Clinic's activities. However, as a seasoned operator of hospitals and health systems, I think attacking the CON as a villain of monopoly-building and price inflation should be tempered with the "why" there was the thought for the laws in the first place. If outpatient competition is(good) for communities wholesale, then how are disparities in access/availability/acuity and regulatory burden addressed now that DSH is eradicated? An example - a local outpatient imaging center opens up across the street from Hernia Memorial Hospital. It has (transparent) prices on outpatient CT, MRI and ultrasound procedures. Let's assume they are 15-20% lower cost to payors/customers than the comparable same examinations at HMH. Steerage from the BUCAHs will occur with lightening speed. So, the YOY OP revenue to HMH will start to wilt. Why is this a problem? It could be that the pricing/revenue differential covered some of the grossly underfunded maternity/critical ICU/ER/Behavioral care that this and most communities manage. We all know what living on CMS-based reimbursements alone does to the futures of hospitals, so I won't bore you. However, the vastly uneven legal (EMTALA), regulatory (State, CMS, etc.) and cost of services (OB, ER, ICU, Trauma) burden that MHM has to fund hour-by-hour needs some funding at a differential for sustainability. I have probably not done the example justice as I am not much of a writer. I only wanted to say that we will need something for whatever we as a country deem as essential services for our communities to be supported. So many more hospitals are just trying to fund their next nursing shift and only serve their local communities, not the UAE. Again, well done.
I really appreciate the thoughtful comment. And I agree with you. It's not that the spirit of CON laws are wrong, it's more how these are taken advantage of. Isn't that always the case? Large organizations find ways to leverage and influence laws to serve their own interests. Nonetheless, it's why wholesale reform across reimbursement models is so sorely needed. Thank you again for the amazing addition to the discussion.
Preston, this is awesome! I love your writing style and how easily you break down the nonsense complexity we're dealing with in American healthcare. Someday, I'd love to read your thoughts on what everyone seems to be clamoring for -- universal healthcare, medical for all, single payer, or whatever else people are calling it these days. For me, it's the idea that we throw our hands up and say, "we give up" and bend over and let the system have its way with us. I hate it when people say, "every other country in the world does healthcare like this except us". I really need to come up with a better reply but the only one I've come up with to date is "sure, plenty of other countries in the world slaughter their own people with machine guns and chemical weapons but I'm certainly not advocating we copy them on that either". I know, it's not a great comeback. I'm just not a "give up and let the other side win" kind of girl. Anyway, thank you for this great blog. I really like it.
I appreciate it! I do have thoughts on Universal healthcare. It takes a full redesign of the financial models. One day maybe I will have the time to really flesh it out and put numbers behind it.