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Posted: 4/18/2024 7:59:43 AM EDT
[#1]
Quote HistoryOriginally Posted By godzillamax: This post should be called 'how to tell people you've never worked at a hospital without telling people you've never worked at a hospital.' Without those layers of admin who is going to manage the housekeepers? Who is going to manage the maintenance/facility staff/department? Who is going to manage the IT staff/department? Who is going to manage the QA/QI staff/department? Who is going to manage the patient scheduling staff/department? Who is going to manage the security staff/department? Who is going to manage the billing staff/department? Who is going to manage clinical/nurse staff scheduling? Who is going to manage the purchasing/supply staff/department? Who is going to do emergency preparednes/management? Who is going to do manage the AP staff/department? Who is going to manage the volunteer program? Who is going to handle physician scheduling? I could go on and on, but point being all these "too many administrators" types just have zero clue how complex a hospital is to run. And clinical staff still far outnumbered Admin staff by a significant margin. Quote HistoryOriginally Posted By godzillamax: Originally Posted By C-4: Originally Posted By killstick_engaged: Originally Posted By bayouhazard: Can't make enough money if there are too many healthy people or not enough sick people? You need staff to bill for services. They don't have staff. Couple things mentioned already CEO and admin probably make tons of cash still Providers who provide actual services (physicians, PAs, and since it's Wyoming, nurse practitioners) are not incentivize to work there because the pay for them is shit. Even though they and the taxpayer are the primary ones whose work keeps the lights on. Donald Trump and his cabinet figured this out and tried to get NPs and PAs better reimbursement. It's always the same song and dance with these 'failing' places. They want money but don't want to incentivize people to work there because it involves paying money to make money. Note how the article touts medicaid expansion at the end , once more putting the burden on the taxpayer while not actually solving any problems. Pay actual providers more and they will come. God forbid admin take a pay cut tho @killstick_engaged +1 It doesn't matter how rural you are, hospitals always have no problem finding more administrators. It's amazing how many layers of administrators they have, one supervising the other, and wonder why they don't have money to hire doctors and nurses who actually bring in the money. lol, the last CEO managed the hospital into bankruptcy. The new hospital system is on their way to doing the same thing. I get it, you hate nurses and doctors as per your previous posts in other threads. Administration doesn’t listen to those of us in the trenches, the people that actually know what is happening. FYI—we had no problem managing a large multi-specialty clinic with all the same departments. If we were able to charge a facility fee surcharge, we would still be in business. |
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Posted: 4/18/2024 8:07:50 AM EDT
[#2]
Quote HistoryOriginally Posted By skid2041: @C-4 I agree, truly. Local hospitals USED to be able to do great things.... now most Doctors have turned to cookbook medicine and won't take risks because of legal liability and how their Management won't allow. It's really sad. I realize they still can handle much. But they aren't more than a urgent care or stand alone ER at this point. Medicare & medicaid require volume, not quality, to make money. Heck, a major trauma to trauma center nets them $100k + per pt from the government. Otherwise there wouldn't be trauma centers. It's all about $ Quote HistoryOriginally Posted By skid2041: Originally Posted By C-4: Originally Posted By skid2041: Good, they are only "feeder" hospitals for bigger networks anyways. They have ambulances transport there instead of taking to the better, higher capable hospitals, so they can bill the insurance for a stay. Then transport the patient to the higher capable. Causing a delay I'm treatment & possibly death. Get more helicopters and fly the patients. @skid2041 You’d be surprised how much smaller hospitals can theoretically take care of locally. It’s a complicated topic because you have to discuss the hospitalist system which has been a disaster to medicine. @C-4 I agree, truly. Local hospitals USED to be able to do great things.... now most Doctors have turned to cookbook medicine and won't take risks because of legal liability and how their Management won't allow. It's really sad. I realize they still can handle much. But they aren't more than a urgent care or stand alone ER at this point. Medicare & medicaid require volume, not quality, to make money. Heck, a major trauma to trauma center nets them $100k + per pt from the government. Otherwise there wouldn't be trauma centers. It's all about $ @skid2041 +1 Yes, you’re right, used to.  |
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GA, USA
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Posted: 4/18/2024 9:15:06 AM EDT
[#3]
Quote HistoryOriginally Posted By ChuckD05: I mean, she could have it in a bathtub, or bring back midwives? Like we didn't have children before hospitals. Quote HistoryOriginally Posted By ChuckD05: Originally Posted By HIMARS13A: ARFcom loves to bloviate about the moral superiority of people who "live rural" but when those rural areas are having their economies hollowed out they cheer it on rather than try to stop it. How dare you...the newborns need those various dozen Big Pharma vaccinations! I hope we're not calling into question the integrity of the Federal Government here! |
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Posted: 4/18/2024 9:22:59 AM EDT
[Last Edit: Waldo]
[#4]
Quote HistoryOriginally Posted By OregonShooter: I will judge. It's "life flight " There is inherent risk involved with flying in order to save a life. Apparently thier insurance companies are unwilling to allow flights in marginal weather. When my brother was in a logging accident life flight refused to fly due to cloud cover. Frustrated EMS called the coast guard which was able to fly inland and get him to a trauma center from the woods. If you want to call yourself an emergency air medivac you better have the fucking equipment and skills to fly. Apparently it's a glorified air tour operator with medics on staff. It's pathetic. They have minimums they can't fly under. That's how aviation works in the US. Life Flights are basically a medical air taxi with a flight nurse and equipment. The Coast Guard/ mil helos have all kinds of advanced gear and training that lets them operate in bad conditions as dedicated SAR birds/crews. Big difference. |
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MS, USA
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Posted: 4/18/2024 9:51:36 AM EDT
[#5]
Rural hospitals should not have a critical care unit, an OB wing or surgery suite.
They should have an ER, a radiology dept and an extra floor or two for overflow with the intention of moving every patient out of the hospital before 10pm every day to either a level II or level I hospital or home. |
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WY, USA
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Posted: 4/18/2024 3:18:20 PM EDT
[#6]
Quote HistoryOriginally Posted By XxbatraiderxX: Rural hospitals should not have a critical care unit, an OB wing or surgery suite. They should have an ER, a radiology dept and an extra floor or two for overflow with the intention of moving every patient out of the hospital before 10pm every day to either a level II or level I hospital or home. That is foolish. Many absolutely should have an OR, and should remain solvent by doing elective cases. With Ortho, general, and uro coverage they can cover most of the urgent/emergent type stuff and avoid sending people many hours away for simple cases that are suitable for even an ASC. Keeping some patients overnight is much more cost effective than transferring, and way more convenient for the patients and families. It doesn't make sense to transfer someone many hours away just to get a couple days of IV ABX for pneumonia or an infected wound. I agree that most shouldn't have OB. The volume isn't there for it to be high quality nor cost effective. One thing a lot of people in this thread don't seem to appreciate is the diversity of rural hospitals. Some are just down the road an hour from major hospitals. Others are several hours away even by air from the nearest alternative. Some have a small population they serve. Others may be in a small town but be the only hospital around for hundreds of miles, with people in a couple of counties seeking care there. Some provide a shitload of services on an outpatient basis and are highly profitable, others are merely ERs with a couple inaptient beds staffed by the same PA/NP. |
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Posted: 4/18/2024 4:27:00 PM EDT
[Last Edit: godzillamax]
[#7]
Quote HistoryOriginally Posted By C-4: lol, the last CEO managed the hospital into bankruptcy. The new hospital system is on their way to doing the same thing. I get it, you hate nurses and doctors as per your previous posts in other threads. Administration doesn't listen to those of us in the trenches, the people that actually know what is happening. FYI we had no problem managing a large multi-specialty clinic with all the same departments. If we were able to charge a facility fee surcharge, we would still be in business. |
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FL, USA
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Posted: 4/18/2024 4:38:18 PM EDT
[Last Edit: jsnappa]
[#8]
Quote HistoryOriginally Posted By Primetime_1: The problems are 1. Lawyers- Most "good medicine" will pick up an emergency 98% of the time. This is safe and cost effective medicine. Lawyers hold us (I work in an ER) to a 0% miss rate. This in not only impossible (our tests aren't perfect), it also makes the cost of medicine essentially go to infinity. I get the comparisons to the airlines, etc. They're not applicable...the police don't bring a violent drunk aboard an airplane and tell the pilot to deal with it. 2. Patient expectations- patients want Monday 8am care at 2AM on Christmas morning, and want it to cost the same. That's not reasonable. Emergency care is THE most expensive healthcare. A Chlamydia test after hours will cost more than an outpatient one....it always will. "Just an xray" in the ER is a registration person, triage nurse, room nurse, physician/PA/NP, xray tech and radiologist. It costs more because an orthopedist has 3 less people to employ. Patients also want this care fast, so hospitals employ NPs and PAs...they really bad ones just let these two groups do EVERYTHING. We get some WILD transfers from these places. My shop has all Board Certified EM docs, and we're expensive, but we can generally get the job done. 3. Regulation- It's crushing....I think we have more nurses in admin than on the floor. "Trauma coordinators" trying to tell docs that trained at trauma centers how to practice, and "patient experience coordinators" doing endless spreadsheets and powerpoints about nothing. My favorite is Utilization Management. An office full of burned out nurses from the floors evaluating the appropriateness and medical necessity of treatment/interventions ordered by board certified physicians. Even from this RN’s pov, it’s absurd. |
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Posted: 4/18/2024 4:48:12 PM EDT
[#9]
Quote HistoryOriginally Posted By HIMARS13A: Are they as good as a 12 lead? We have a SmartHeart for the clinic, it's pretty cool, my wife says it's harder to read than a 12 lead but it's a lot easier and more portable. I don't see how, but there quite a few arrythmias that you don't need a 12 lead for. |
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Posted: 4/18/2024 4:50:12 PM EDT
[#10]
Quote HistoryOriginally Posted By HIMARS13A: The last time anyone in my family saw an NP she ordered the wrong labs and prescribed the wrong prescription. It cost over $400 and it was completely unusable. I see doctors correcting meds after just a dumb 'ol regular nurse calls them on it daily..... GD and their broad brushes never fails to amuse. |
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Posted: 4/18/2024 4:55:09 PM EDT
[#11]
Quote HistoryOriginally Posted By skid2041: Great! You are a Level 2! You get a ton of money from the Federal government. That's a HUGE difference between my 2 "local" ones (20mins) 6-medsurg, 6 ER beds, & the one 1hr away, slightly more. Everything gets flown or driven to the bigger city hospitals. I realize I'm broad brushing. But it's a conversation needed to be had. Everyone is using ER's and hospitals as primary care. Point of service (at their homes) can be a thing again (and is starting to be in some areas because of cost). Everything is mobile now. Even surg suites. It can be done & at lower cost with good reimbursement. "Point of service" at home? Yeah....I know two docs that do that. I can't afford it and I'm not a poors. Mobile Surgical Suits....in a combat zone.  You are my favorite poster! |
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Posted: 4/18/2024 4:56:42 PM EDT
[#12]
Quote HistoryOriginally Posted By jsnappa: Mortality isn’t nearly that high, besides, no one (of course very few do) dies on the surgical table. Especially if you can get them to someone like Dr. Tomas Martin or the surgeons he’s trained. A robust transport network is key. Quote HistoryOriginally Posted By jsnappa: Originally Posted By skid2041: If they are dissecting, depending on how soon or what kind, they are probably dead anyways. Even on a surg table. Mortality isn’t nearly that high, besides, no one (of course very few do) dies on the surgical table. Especially if you can get them to someone like Dr. Tomas Martin or the surgeons he’s trained. A robust transport network is key. Ha. Transport to the SICU before they expire.... 
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AZ, USA
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Posted: 4/18/2024 5:02:57 PM EDT
[#13]
Quote HistoryOriginally Posted By HELOBRAVO: I see doctors correcting meds after just a dumb 'ol regular nurse calls them on it daily..... GD and their broad brushes never fails to amuse. If FNPs are sufficient why do we require MDs have a residency to practice? |
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FL, USA
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Posted: 4/18/2024 5:10:56 PM EDT
[#14]
Quote HistoryOriginally Posted By HELOBRAVO: Ha. Transport to the SICU before they expire.... Quote HistoryOriginally Posted By HELOBRAVO: Originally Posted By jsnappa: Originally Posted By skid2041: If they are dissecting, depending on how soon or what kind, they are probably dead anyways. Even on a surg table. Mortality isn’t nearly that high, besides, no one (of course very few do) dies on the surgical table. Especially if you can get them to someone like Dr. Tomas Martin or the surgeons he’s trained. A robust transport network is key. Ha. Transport to the SICU before they expire.... The huge syringe in the anesthesiologist’s right hand is enough levophed to get them from the OR to the SICU without running. |
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Posted: 4/18/2024 8:42:47 PM EDT
[#15]
Quote HistoryOriginally Posted By HELOBRAVO: I don't see how, but there quite a few arrythmias that you don't need a 12 lead for. Quote HistoryOriginally Posted By HELOBRAVO: Originally Posted By HIMARS13A: Are they as good as a 12 lead? We have a SmartHeart for the clinic, it's pretty cool, my wife says it's harder to read than a 12 lead but it's a lot easier and more portable. I don't see how, but there quite a few arrythmias that you don't need a 12 lead for. Most treatable arythmias only need a 3/4-lead. |
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Posted: 4/18/2024 8:47:14 PM EDT
[#16]
Quote HistoryOriginally Posted By HELOBRAVO: "Point of service" at home? Yeah....I know two docs that do that. I can't afford it and I'm not a poors. Mobile Surgical Suits....in a combat zone. You are my favorite poster! Quote HistoryOriginally Posted By HELOBRAVO: Originally Posted By skid2041: Great! You are a Level 2! You get a ton of money from the Federal government. That's a HUGE difference between my 2 "local" ones (20mins) 6-medsurg, 6 ER beds, & the one 1hr away, slightly more. Everything gets flown or driven to the bigger city hospitals. I realize I'm broad brushing. But it's a conversation needed to be had. Everyone is using ER's and hospitals as primary care. Point of service (at their homes) can be a thing again (and is starting to be in some areas because of cost). Everything is mobile now. Even surg suites. It can be done & at lower cost with good reimbursement. "Point of service" at home? Yeah....I know two docs that do that. I can't afford it and I'm not a poors. Mobile Surgical Suits....in a combat zone. You are my favorite poster! I've seen & spoken to a group of OB/Gyns looking into a mock-up. Home births with a trailer set-up as a rapid suite for c-sections. It's doable. But not feasible with insurance. These doctors are trying to start a subscription service. Many doctors are trying to unplug from the insurance system. Obviously, not for the poor. Maybe someday. The systems now are massively overloaded. With only money grabs and no fixes in the future. Sad. |
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Posted: 4/18/2024 8:48:53 PM EDT
[#17]
Quote HistoryOriginally Posted By jsnappa: The huge syringe in the anesthesiologist’s right hand is enough levophed to get them from the OR to the SICU without running. Quote HistoryOriginally Posted By jsnappa: Originally Posted By HELOBRAVO: Originally Posted By jsnappa: Originally Posted By skid2041: If they are dissecting, depending on how soon or what kind, they are probably dead anyways. Even on a surg table. Mortality isn’t nearly that high, besides, no one (of course very few do) dies on the surgical table. Especially if you can get them to someone like Dr. Tomas Martin or the surgeons he’s trained. A robust transport network is key. Ha. Transport to the SICU before they expire.... The huge syringe in the anesthesiologist’s right hand is enough levophed to get them from the OR to the SICU without running. Oooo push dose Levo. That's fun. 
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Posted: 4/19/2024 9:33:56 AM EDT
[#18]
Quote HistoryOriginally Posted By HIMARS13A: OB wards are closing all over because reimbursements are too low The solution to that is a complete restructuring of medical reimbursement from Medicare/Medicaid/private insurance. Way above our pay grade. Society has to decide what is important to it. It’s truly a messed up situation. |
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Posted: 4/19/2024 9:35:34 AM EDT
[#19]
Quote HistoryOriginally Posted By C-4: The solution to that is a complete restructuring of medical reimbursement from Medicare/Medicaid/private insurance. Way above our pay grade. Society has to decide what is important to it. It’s truly a messed up situation. Quote HistoryOriginally Posted By C-4: Originally Posted By HIMARS13A: OB wards are closing all over because reimbursements are too low The solution to that is a complete restructuring of medical reimbursement from Medicare/Medicaid/private insurance. Way above our pay grade. Society has to decide what is important to it. It’s truly a messed up situation. How about getting the government out of the medical field all together. (Won't ever happen) |
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