From the website:

“Jackson South is currently a 199-bed acute-care hospital located in south Miami-Dade County. Construction is underway to increase our size by 157,000 square feet and renovate an additional 72,000 square feet of existing space. This exciting project will expand our emergency room and surgical facilities and will add 57 new private patient rooms. It will also convert existing semi-private rooms to private rooms. Dining areas, and the diagnostic imaging and critical care units will be remodeled as well. “

The Miami-Dade hospital provided over 600 million in charity care, but was reimbursed 400 million, so there’s the 200 million outstanding.  In California we are looking at some of the same potential shortfalls and there’s some additional hospital closures happening in New York too.   The state legislators are “trying” to speed up the emergency recovery money from 30 to 15 days and is hoping the federal government makes the proposed Medicaid changes.  This is one big huge reason that healthcare reform is done, and done right, as the state has their own deficit of over 3 billion to deal with as well, so you get the picture here that not much is being done currently except a lot of talking about how “broke” everyone is and healthcare suffers. 

A year ago, this is what was on the blog here and for a short while there seemed to be some reprieves with layoffs and closures, it all seems to have bounced right back.  BD

Desperate Hospitals Update – April 2009

Hospital officials did not provide details, but CBS4 news partner The Miami Herald obtained the following email by a board member expressing frustration.

In an e-mail obtained by The Herald Friday to Jackson President & CEO Eneida Roldan, board member Martin Zilber said: ``I am very strongly in favor of a meeting with our fellow stakeholders. However, I am concerned about doing so as a full board and at such a public setting. Perhaps you and senior leadership should meet with leadership of our partner organizations first. I know you are pushing for transparency and board inclusion, however, I believe the next time our board meets, we need to know how our partners are willing to help and be presented with options so our board can take action and make an intelligent decision.''

And while legislators were sympathetic, they turned down her request saying the state faced its own budget crisis with a deficit of $3.2 billion.
Jackson receives $77 million in state money every 30 days and Miami legislators said they would work to try to get the money to the hospital sooner in 15-day increments rather than monthly. 
On March 6, Roldan announced plans to lay off 4,487 workers and close two of the system's hospitals – Jackson North and South -- in response to a $229 million dollar budget deficit.

Jackson Cancels Board Meeting To Discuss Plan - cbs4.com

The CEO of the hospital sums it up pretty good, it’s about the economy and hospitals can only cut so far as they have fixed costs.  Some hospitals around the country have been holding meetings, telling physicians that they “are not meeting quota”.  This means admitting quota.  Perhaps quota is not the best choice of words but that is what is being related to the doctors when the numbers show the hospital is not bringing in enough money to meet their bottom line costs.  To raise more money, admitting “insured” patients and even Medicare patients is a way of generating revenue, even though doctors of course do not want to admit patients who do not need to be there as well, but some are being put on the “hot seat” as if the bottom line revenue goals to keep the doors open are not met, well the hospital can fade away as well.  It’s really a very bad situation.  If physicians admit patients who do not need to be there, the utilization departments will track this down as this is their job and the doctor could get fired when those algorithms are run later, so a big catch 22. 

The doctor can feel pressured and perhaps admit borderline cases, but when the numbers are run later, he’s out the door at the hospital and he could also be replaced by other doctors who charge less, or perhaps I should say may be coerced into charging less.  BD 

LOUISVILLE, KY (WAVE) - Another major Louisville company is cutting jobs. On Wednesday, Jewish Hospital and St. Mary's HealthCare announced it would eliminate 500 of its more than 8,100 positions, about half through layoffs.

Interim CEO Janice James says it's "about as tough as you get in terms of management decisions."

James says about 250 employees now working for Jewish and St. Mary's won't have jobs at the end of the month.

"This isn't about the people's contributions individually," James said. "This is about a change in the economic reality that we live in."

The economy is finally hitting healthcare.

"Patients are deferring elective services," James explained. "A lot of the COBRA support that was there has come to an end for people who lost their jobs."

In addition, Jewish is contracting out its food and environmental services, meaning those employees will soon work for a new company.

"Those people will still be working here," James said. "They'll just be working in a different employment relationship."

Jewish Hospital & St. Mary's HealthCare to cut 500 positions - WAVE 3 TV Louisville, KY |

They also have a page on the website to sell you some nutritional products and devices. Is this the next move with wellness and fitness with insurance companies beginning to buy the gyms?  There are more than 2 million members in the northwest.  Regence Blue Shield had offered the plan to their own employees for the last year. 

From the website:

“ Kinetix offers a variety of programs to our corporate clients. These are customized programs that can be implemented effectively whether your employees sit in one location, are distributed in many locations, or a combination of both. Our product line has been designed to give our clients maximum flexibility and freedom while delivering consistent and measurable results.”

SEATTLE, Mar 10, 2010 (BUSINESS WIRE) -- Maveron LLC, a Seattle-based venture capital firm focused on helping exceptional entrepreneurs build great consumer businesses, announced the asset acquisition of portfolio company Kinetix Living Corp. by Regence BlueShield of Washington. Terms of the transaction were not disclosed. 

Kinetix, a Seattle-based company that helps people get and stay in the best shape of their lives, provides customized health and nutrition programs to corporate clients and individuals across the country. Kinetix has built a compelling, scalable and integrated business based on three pillars: fitness, nutrition and a supportive online community that promotes wellness at work and at home.

http://www.marketwatch.com/story/maveron-backed-health-and-wellness-company-kinetix-acquired-by-regence-blueshield-2010-03-10?reflink=MW_news_stmp

I might go on to guess that with negotiated contracts with the doctors and the visits sometimes being free, there goes less in the pockets of the doctors too.  It took some fancy formulas (algorithms) to come up with this one.  Actually it’s not the small routine expenses for preventive care that hurts everybody, it’s the large expenses and this is an option for employees, and yes, just one more way of crunching numbers with some new algorithms.  The plans are being underwritten by Blue Cross/Blue Shield.  It’s just one more way to shake out some numbers, and add to the confusion of getting good care.  As far as I have seen and heard from individuals I talk with, not much of this is really getting though as most patients don’t understand the entire analytics of the process.  

Workers at a Portland, Ore., steel mill soon will be able to pick a new type of insurance that offers free care for some illnesses, such as diabetes or depression, but requires hefty extra fees for treatments deemed overused, including knee replacements, hysterectomies and heart bypass surgery.

The insurance, which will be offered by five different insurers in Oregon, is the most far-reaching and potentially controversial step in an effort by employers nationally to rein in medical spending by redesigning health benefits.

"We're trying to make people better consumers," says John Worcester, head of benefits at Evraz Oregon Steel, the sole employer to sign up since the plans began coming on the market earlier this year.

Workers who choose the option over a more traditional plan next year could see their costs drop sharply if they have one of six chronic conditions but might pay hundreds more in deductibles and co-payments if they need a hip replacement or a heart stent.

At Evraz, Worcester expects only about 30 of the 450 workers at the plant will choose the new option over more conventional insurance — even though the company won't charge workers monthly premiums for the new type of policy. The policies, administered by Regence Blue Cross Blue Shield, will work like this:

Just as in more traditional insurance plans, workers would pay an annual deductible of about $250 before coverage kicks in. Doctor office visits would cost workers $10 to $20. Employees would pay 20% of the cost of hospital care, up to an annual maximum of $1,500 for individuals and $3,000 a year for family coverage.

But employees with certain conditions — asthma, congestive heart failure, diabetes, depression, heart disease, chronic bronchitis or emphysema — would get prescription drugs and visits with physicians free or at greatly reduced rates. High blood pressure, another common condition, would qualify for low-cost care if it was part of an overall diagnosis of heart disease.

Conversely, they'd pay much more if they have a treatment or test from a list of about 20 broad categories, including knee or hip replacement, cardiac bypass surgery, artery-opening stents, hysterectomies, high-tech-imaging exams or emergency room visits. In those cases, they'd pay double the annual deductible, double the amount they'd normally pay for an office visit and up to half the cost of hospital or ER visit, up to the $1,500/$3,000 maximums.

Insurers test health plans that stress patient choices - USATODAY.com

And yet the backlash against managed care continues. Health insurers are being beaten over the head by politicians and others. No doubt some of the criticism is justified, because there are plenty of abuses to be found. But the popular view that cracking down on insurers is going to solve the health care cost crisis is dangerously misguided. Bashing health plans gives others –especially hospitals, clinics, doctors, patients, employers, politicians and regulators– a free pass. The big drivers of health care premiums are volume of health care consumed and rising prices, which are not caused by health plans.

Even the debate about pre-existing conditions is not so straightforward. It’s considered a given at this point that health plans shouldn’t discriminate against people with pre-existing conditions. Yet the fact remains that pre-existing conditions drive up the cost of insuring an individual.

Contrast this situation with other areas of insurance. I am in the process of upgrading my disability insurance, and you can be certain the insurance company is taking steps to make sure I’m a good risk. That means asking medical and lifestyle questions and subjecting me to a physical examination that includes blood and urine tests. It’s the same thing with life insurance. Although it’s unfortunate for people in poor health, this system at least keeps premiums affordable for those at low risk.

Don’t get me wrong. I’d also like to see a ban on discrimination based on pre-existing conditions. But this does have to be coupled with mandated coverage in order to bring the whole population into the risk pool.

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