Obamacare forces 93000 hospital job cuts in 2013, NC hospitals costs up $7.5 billion the next 10 years, Medicare and Medicaid reimbursements, Mass layoffs

“Nobody who makes under $200,000 a year will see their taxes go up as long as I’m president.”…Barack Obama

“I absolutely reject that notion [mandate is a tax].”…Barack Obama

“Glenn Beck has presented the frightening spectre of Christmas past created by Obama. But as in Dickens’ “A Christmas Carol”  it is the Ghost of Christmas Future that frightens me. The impact of Obamacare on our health care system and the combined impact of Obamacare and record deficit spending on our economy. The taxes of Christmas future to pay for Obama’s actions.”…Citizen Wells June 30, 2012

By March 26, 2010 I referred to Obamacare as a tax and control bill.

From the Greensboro News Record November 25, 2012.

“Hospitals feeling the pinch”

“Wake Forest Baptist Medical Center launched a distress signal in a gathering storm when it said on Nov. 14 that it will cut 950 jobs.

That storm has at its center national health care reform, possible lower reimbursements for Medicare and Medicaid services, and an increasing number of older patients who need more care.

The hospital industry is in for a direct hit — that’s not in doubt.

But mass layoffs may be only one of many solutions for the health care industry’s problems.

The problem for hospitals is choosing the right one: mass layoffs, refined management techniques or some middle ground.

Wake Forest declined an interview request for this article. But it has said in other accounts that the roughly 6 percent staff cut is a pre-emptive measure for expected budget cuts and rising costs. And it expects remaining workers will become more productive as a result.

That’s a delicate balance, said Mark Graban, a national expert and consultant on health care management who lives in San Antonio, Texas.

“It’s easy to add up the cost savings of reduced payroll,” he said. “But it’s hard to add up the side effect of those layoffs.”

He said layoffs are sweeping the industry. Graban referred to a report from the American Hospital Association that says hospitals will cut 93,000 jobs during 2013.

Wake Forest and other major hospitals across the nation pledge that nurse-to-patient ratios won’t change despite the job cuts. Graban said that simple pledge may only mask lingering problems that hurt the quality of patient care.

Nurses and other professional staff, for example, see the headlines, see friends who may be laid off and work in fear, he said.

“A lot of times, quality and good patient outcomes are a result of nurses and other staff going above and beyond,” Graban said. “My concern would be not that the professionals are going to get lazy, but are they going to continue to be motivated to go above and beyond?”

Across the nation, he said, many medical centers are choosing “no layoff” policies and using management techniques pioneered in industry.

“Lean management” is a term many industries use for a variety of techniques that train workers to improve performance, make fewer mistakes and work with higher morale, he said.

Lean does not mean, as many joke, “Less Employees Are Needed.”

Graban worked with one hospital, ThedaCare in Appleton, Wis., which typifies the technique. The medium-size hospital manages conservatively, he said, doesn’t over-hire workers and saves cash for slow times.

Don Dalton, the spokesman for the N.C. Hospital Association, said hospitals throughout the state are using lean-management techniques — especially the smallest hospitals.

The coming changes could cost North Carolina’s hospitals up to $7.5 billion over the next 10 years , Dalton said.

With limited resources, the state’s small and medium-size hospitals feel financial pressure first, he said. So they are looking for any way they can to operate without compromising service.

Hospitals are combining resources to save money. In some cases, that means nothing more than “group buying” of supplies and services — lower prices for bulk buyers.

On a larger scale, Greensboro’s Cone Health signed a managing partnership earlier this year with Carolinas Health Systems in Charlotte.

Doug Allred, the spokesman for Cone, which employs more than 8,000 people , said: “We do not have plans for any layoffs right now.”

When asked to discuss issues facing the hospital industry in general, Allred said: “We are going to decline” an interview.

Jeffrey Miller, the president of High Point Regional Health System , freely discusses what led to the hospital’s planned merger with UNC Health Care.

He said that many unemployed people in the Triad don’t have health insurance, and those who do find that rising deductibles are too expensive.

“So we have a bad-debt problem,” Miller said.

Federal Medicare reimbursements have declined or remained flat, and the program is asking hospitals to fill out more documents to justify expenses.

And finally, the state, which administers Medicaid programs, is cutting its own stretched budget and program reimbursements.

As a result, High Point Regional has operated at a loss for two years. With its 2,212 workers, the hospital lost $40.8 million on unreimbursed care last year.

“It’s coming at us from all directions,” Miller said.

Through careful expense control, Miller said, High Point has not laid off workers, but it has had to cut hours from time to time to save money — and jobs.

Saving money, changing the way a hospital works, changing the way hospitals work together — all are key issues for UNC Health Care and its subsidiaries, said Karen McCall, vice president of public affairs and marketing for the system.

“We need to reduce costs, and all of us are aware of that and we’re trying to take steps to be able to do that through re-engineering,” she said.

Lean management is a big part of how UNC has managed its hospitals.

“It’s really been a core value at UNC for quite some time.”

UNC is planning for a difficult future, especially the unknown effects of more insured people and a growing population of older people who will need more care.

UNC plans to create a system in which each patient has a “medical home,” or a central doctor and staff that can manage the patient’s total care. That doctor would coordinate care from specialists and a variety of other services.

But getting there, McCall said, means spending more money to upgrade technology.

Finally, UNC is constantly keeping an eye on its employees to make sure their morale is good.

“Having worked very, very hard with patient satisfaction, the key to patient satisfaction is employee satisfaction,” she said. “Employee satisfaction is just very important and it’s something we measure and take into consideration all the time.

“We’re looking for best practices outside the industry,” McCall said. “But I really feel that we’re not the only ones doing that. Everyone in health care looking to the future feels that’s very necessary.””

http://www.news-record.com/content/2012/11/24/article/hospitals_feeling_the_pinch