Life Altering Events

[MU82]

"Seem to be doing A-OK" is pretty vague. Do you have numbers on which you base this, or are you assuming it based on expansion? Because getting bigger is not the same as getting more profitable.

They're not supposed to be "profitable" at all. They're a not-for-profit hospital system.

[GooooMarquette]

They're not supposed to be "profitable" at all. They're a not-for-profit hospital system.

You don't understand not-for-profit very well, do you?

They are allowed to finish the year in the black, as long as those dollars are not given to owners/shareholders. Most larger healthcare places put any such money into research or education.

For reference, check out IRS Sec. 501(c)(3). You're welcome.

[MU82]

You don't understand not-for-profit very well, do you?

They are allowed to finish the year in the black, as long as those dollars are not given to owners/shareholders. Most larger healthcare places put any such money into research or education.

For reference, check out IRS Sec. 501(c)(3). You're welcome.

I am quite certain that Atrium Health is raking it in. Its executives certainly are.

[ZiggysFryBoy]

I am quite certain that Atrium Health is raking it in. Its executives certainly are.

Atrium made $5m on revenue less expenses in 2017 (most recent tax year available.)  The president made half a mil.  The SVP made $400k.  Those are the 2 highest paid executives.   I'm guessing the doctors belong to a separate organization, as they would be top earners too and aren't listed.

Their total liabilities are $5 on $355m in assets, 2 years in a row.  Looks like a pretty well run organization.

I'd find another evil corporation to rail against if i were you. OMB.

[MUBurrow]

Atrium made $5m on revenue less expenses in 2017 (most recent tax year available.)  The president made half a mil.  The SVP made $400k.  Those are the 2 highest paid executives.   I'm guessing the doctors belong to a separate organization, as they would be top earners too and aren't listed.

Their total liabilities are $5 on $355m in assets, 2 years in a row.  Looks like a pretty well run organization.

I'd find another evil corporation to rail against if i were you. OMB.

+1.  This looks like a pretty lean org, actually.  If you're going to call $5M in the black for an organization that employes 65,000 people "raking it in," what would be a responsible net annual revenue?

[ZiggysFryBoy]

+1.  This looks like a pretty lean org, actually.  If you're going to call $5M in the black for an organization that employes 65,000 people "raking it in," what would be a responsible net annual revenue?

I dont know the ins and outs of hospital balance sheets, so no idea what is responsible net earnings would be.

But 82 thinks they are running a slush fund for the gat cats, which their tax forms clearly shows not to be the case.  Maybe Mr. lack of impulse control should do a simple search before throwing chit against the fan.

[GooooMarquette]

Atrium made $5m on revenue less expenses in 2017 (most recent tax year available.)  The president made half a mil.  The SVP made $400k.  Those are the 2 highest paid executives.   I'm guessing the doctors belong to a separate organization, as they would be top earners too and aren't listed.

Their total liabilities are $5 on $355m in assets, 2 years in a row.  Looks like a pretty well run organization.

I'd find another evil corporation to rail against if i were you. OMB.

Yep. And you would find similar stories if you look into most large healthcare providers. They are expanding as 82 noted, but it isn't because they're flush with cash; it's to find ways to operate more efficiently as reimbursement levels decline. The big profits in healthcare are in the drug and device companies.

[Coleman]

Yep. And you would find similar stories if you look into most large healthcare providers. They are expanding as 82 noted, but it isn't because they're flush with cash; it's to find ways to operate more efficiently as reimbursement levels decline. The big profits in healthcare are in the drug and device companies.

Maybe, but at least they are innovating and bringing new products to market (outside of some bad apples)

If you are looking for someone to blame, What value do health insurance companies add?

[jesmu84]

Maybe, but at least they are innovating and bringing new products to market (outside of some bad apples)

If you are looking for someone to blame, What value do health insurance companies add?

Insurance>drugs/devices>hospitals

[MU82]

Atrium made $5m on revenue less expenses in 2017 (most recent tax year available.)  The president made half a mil.  The SVP made $400k.  Those are the 2 highest paid executives.   I'm guessing the doctors belong to a separate organization, as they would be top earners too and aren't listed.

Their total liabilities are $5 on $355m in assets, 2 years in a row.  Looks like a pretty well run organization.

I'd find another evil corporation to rail against if i were you. OMB.

I dont know the ins and outs of hospital balance sheets, so no idea what is responsible net earnings would be.

But 82 thinks they are running a slush fund for the gat cats, which their tax forms clearly shows not to be the case.  Maybe Mr. lack of impulse control should do a simple search before throwing chit against the fan.

Not sure where you're getting your info on the pay at Atrium, but here's where I'm getting mine:

https://www.charlotteobserver.com/news/business/article240093133.html

Atrium Health paid top officer Gene Woods nearly $7.3 million in total compensation last year — an increase of about 19% from the year before, according to the hospital system’s compensation disclosure released Friday.

CEO Woods got a base salary of about $2.7 million in 2019, up from $1.7 million the year before.

His 2019 package included a bonus of $2.4 million and about $2.2 million in other benefits.

In 2018, Woods made about $6.1 million in total compensation. The year before, he made about $5.4 million.

The Charlotte-based not-for-profit hospital system said in a statement that compensation of its top 10 executives is equal to less than 1% of total compensation for all employees.

Atrium’s top 10 highest paid executives make more than $26.4 million in total compensation, according to the financial disclosure.

The article includes a PDF of the high-paid executives, released by the hospital system itself. A few years back, the Observer did an award-winning series about both the good and bad at Atrium (then Carolinas Heathcare). I remember one article about even as they were giving their executives 20% raises, they were bankrupting patients who were earning $20K per year. You think that's cool; I think it's not the best, especially for a not-for-profit hospital.

I don't think Atrium is "evil." My wife works for them and they've been an OK employer. Not great, but certainly not bad. They do a lot of charitable work, they are very visible in the community. They recently have stepped up to increase their minimum wage, give better raises to those who aren't executives, and the like. It's progress.

There were many years in which my wife got the highest ratings an RN could possibly get in annual reviews and received a 1.5% raise on her comparatively meager salary while the executives were getting 20% raises on their 7-figure salaries. But that's life in the big city; like everybody else, I fully realize that the rich always get richer.

As far as their financials, I'll take your word for it ... but you were so far off on the executive pay figures that I do wonder a little.

[GooooMarquette]

Maybe, but at least they are innovating and bringing new products to market (outside of some bad apples)

If you are looking for someone to blame, What value do health insurance companies add?

I wasn't looking for anyone to blame; I was showing that 82 was wrong to claim that healthcare providers are some sort of bloated cash cow.

But since you asked...I will begin by agreeing about the innovations by drug and device companies. They most certainly contribute to our society. Still, there are plenty of innovative companies that have far smaller margins than drug and device companies. So maybe they deserve to be rewarded for their innovation...but perhaps not to the point that they are the epicenter of healthcare industry profits.

As for health insurance companies, I am torn. On the one hand, I can see the merit in the argument that just "adding a middleman" seems costly and unnecessary. On the other, I know that my (very large) company tried for many years to administer its own health plan for employees and family members, but found it so costly and difficult that we ultimately hired a health insurance company to do it for us. And as a beneficiary under that plan, I can assure you that they are doing an excellent job.

I also have extensive experience with claims submission to, and administration by, both private insurers and Medicare. And I can tell you unequivocally that private insurers are MUCH more efficient and easy to work with than CMS. From a billing compliance perspective, providers spend an astronomical amount of time trying to navigate the byzantine Medicare guidelines, and only occasionally get into significant tussles with a private insurer. So without getting too political...if we are going to expand Medicare to cover more people, I think our best strategy would be to blow the whole thing up and get some health insurance executives to build a new and better system for everyone.

FWIW, I have been working in the healthcare field for 27 years (most of it in regulatory compliance, interacting with drug and device companies, healthcare insurers and CMS)...but take my $0.02 as you wish.

[GooooMarquette]

Insurance>drugs/devices>hospitals

IMO, the problems are:

Drugs/devices>insurance>hospitals (see above for more detail).

[MU82]

I wasn't looking for anyone to blame; I was showing that 82 was wrong to claim that healthcare providers are some sort of bloated cash cow.

I did not "claim that healthcare providers are some sort of bloated cash cow."

My exact wording was:

However, I will say that the large "health care systems," many of which began as hospitals (or groups of them) and have morphed into, well, "health care systems," seem to be doing A-OK.
Here in NC, the largest employer is Atrium Health, a ginormous, "not-for-profit" health care system anchored by one huge hospital and numerous satellite hospitals. Over the last couple decades, they swallowed up clinics and small hospitals, used their clout to lure physicians out of private practice, etc.

I went on to say that many rural hospitals are having all kinds of troubles.

Every word of all of that is true, and none of it is me claiming what you claim I'm claiming. I don't mind being criticized; like you and everybody else here, I make mistakes sometimes. But at least make the criticism accurate, please.

[ZiggysFryBoy]

Not sure where you're getting your info on the pay at Atrium, but here's where I'm getting mine:

https://www.charlotteobserver.com/news/business/article240093133.html

Atrium Health paid top officer Gene Woods nearly $7.3 million in total compensation last year — an increase of about 19% from the year before, according to the hospital system’s compensation disclosure released Friday.

CEO Woods got a base salary of about $2.7 million in 2019, up from $1.7 million the year before.

His 2019 package included a bonus of $2.4 million and about $2.2 million in other benefits.

In 2018, Woods made about $6.1 million in total compensation. The year before, he made about $5.4 million.

The Charlotte-based not-for-profit hospital system said in a statement that compensation of its top 10 executives is equal to less than 1% of total compensation for all employees.

Atrium’s top 10 highest paid executives make more than $26.4 million in total compensation, according to the financial disclosure.

The article includes a PDF of the high-paid executives, released by the hospital system itself. A few years back, the Observer did an award-winning series about both the good and bad at Atrium (then Carolinas Heathcare). I remember one article about even as they were giving their executives 20% raises, they were bankrupting patients who were earning $20K per year. You think that's cool; I think it's not the best, especially for a not-for-profit hospital.

I don't think Atrium is "evil." My wife works for them and they've been an OK employer. Not great, but certainly not bad. They do a lot of charitable work, they are very visible in the community. They recently have stepped up to increase their minimum wage, give better raises to those who aren't executives, and the like. It's progress.

There were many years in which my wife got the highest ratings an RN could possibly get in annual reviews and received a 1.5% raise on her comparatively meager salary while the executives were getting 20% raises on their 7-figure salaries. But that's life in the big city; like everybody else, I fully realize that the rich always get richer.

As far as their financials, I'll take your word for it ... but you were so far off on the executive pay figures that I do wonder a little.

Their 2017 form 990.  Find it on guidestar.

Maybe they have some other entities where they pay the big bucks.

[mu03eng]

Insurance companies aren't exactly blood suckers either. They are absolutely necessary to price risk into the transactions. The health care providing system is lumpy by nature and it takes a lot of effort to address that.

Now, you want to drive efficiencies, remove employers from being providers of insurance so to speak and allow insurances to compete across state lines. You will see a huge consolidation of insurance providers which will enable scale and drive efficiency.

[MU82]

Their 2017 form 990.  Find it on guidestar.

Maybe they have some other entities where they pay the big bucks.

I accept your apology. Have a nice day.

[GooooMarquette]

I did not "claim that healthcare providers are some sort of bloated cash cow."

My exact wording was:

However, I will say that the large "health care systems," many of which began as hospitals (or groups of them) and have morphed into, well, "health care systems," seem to be doing A-OK.
Here in NC, the largest employer is Atrium Health, a ginormous, "not-for-profit" health care system anchored by one huge hospital and numerous satellite hospitals. Over the last couple decades, they swallowed up clinics and small hospitals, used their clout to lure physicians out of private practice, etc.

I went on to say that many rural hospitals are having all kinds of troubles.

Every word of all of that is true, and none of it is me claiming what you claim I'm claiming. I don't mind being criticized; like you and everybody else here, I make mistakes sometimes. But at least make the criticism accurate, please.

OK. I hereby criticize you for claiming that our healthcare systems are "doing A-OK."

The systems overall have expended. But as I said in an earlier post, that expansion has been fueled by a need to expand or die, as stagnant overall reimbursement levels, combined with ever more expensive medical equipment and increasingly complicated claims and reimbursement rules, have made it necessary to achieve economies of scale.

Don't believe it?

Thirty hospitals declared for bankruptcy in 2019, amidst a booming economy. https://www.businessinsider.com/us-hospital-financial-woes-unlikely-to-subside-in-2020-2020-1

And it isn't just rural hospitals. It includes Philadelphia's Hahnemann University Hospital, a teaching hospital that includes a level 1 trauma center. https://penntoday.upenn.edu/news/philadelphia-us-hospitals-closing-hahnemann

And even hospitals that don't declare bankruptcy and/or close their doors struggle. Here is an article citing an analysis by MedPAC (a nonpartisan legislative agency that advises Congress about the Medicare program), stating that even the most efficient hospitals operate in the red on Medicare patients. https://www.healthcarefinancenews.com/news/efficient-hospitals-operate-2-margins-medicare-payments-medpac-reports That's right - even "the most efficient" struggle to survive, according to a Congressional advisory group.

That doesn't sound so A-OK to me....

[forgetful]

Taking this away from discussion on hospitals. One possible outcome from this that would be life-altering is a great shift towards Nationalism around the world.

We already saw this emerging around the world for the past several years. But now, people are looking at outsiders as causing the spread of this disease, and reliant on other economies as a causative agent in economic problems from the coronavirus.

We will likely see a further shift then in excluding outsiders and a breakdown in the world economy in favor of national economies.

Some are in favor of this, but everytime we have seen a rise in nationalism, it has been followed by global war.

[MU82]

OK. I hereby criticize you for claiming that our healthcare systems are "doing A-OK."

The systems overall have expended. But as I said in an earlier post, that expansion has been fueled by a need to expand or die, as stagnant overall reimbursement levels, combined with ever more expensive medical equipment and increasingly complicated claims and reimbursement rules, have made it necessary to achieve economies of scale.

Don't believe it?

Thirty hospitals declared for bankruptcy in 2019, amidst a booming economy. https://www.businessinsider.com/us-hospital-financial-woes-unlikely-to-subside-in-2020-2020-1

And it isn't just rural hospitals. It includes Philadelphia's Hahnemann University Hospital, a teaching hospital that includes a level 1 trauma center. https://penntoday.upenn.edu/news/philadelphia-us-hospitals-closing-hahnemann

And even hospitals that don't declare bankruptcy and/or close their doors struggle. Here is an article citing an analysis by MedPAC (a nonpartisan legislative agency that advises Congress about the Medicare program), stating that even the most efficient hospitals operate in the red on Medicare patients. https://www.healthcarefinancenews.com/news/efficient-hospitals-operate-2-margins-medicare-payments-medpac-reports That's right - even "the most efficient" struggle to survive, according to a Congressional advisory group.

That doesn't sound so A-OK to me....

Again, what I said was:

However, I will say that the large "health care systems," many of which began as hospitals (or groups of them) and have morphed into, well, "health care systems," seem to be doing A-OK.

I stand by that, especially if Atrium is representative of most others of their size and scope. Otherwise, I  didn't say most of the stuff you and Ziggy claim I did, nor did I declare Atrium or any other healthcare system was "evil." And I provided data to back my discussion of executive pay at Atrium.

Absolutely, I will acknowledge that many hospitals, clinics and health care providers are doing less than OK. That surprises me, and saddens me, about the Philly hospital.

I hope that's enough to satisfy y'all. If not, well, that's A-OK, too.

[jesmu84]

Taking this away from discussion on hospitals. One possible outcome from this that would be life-altering is a great shift towards Nationalism around the world.

We already saw this emerging around the world for the past several years. But now, people are looking at outsiders as causing the spread of this disease, and reliant on other economies as a causative agent in economic problems from the coronavirus.

We will likely see a further shift then in excluding outsiders and a breakdown in the world economy in favor of national economies.

Some are in favor of this, but everytime we have seen a rise in nationalism, it has been followed by global war.

It's faux/selective nationalism though.

Poor Chinese student entering the country? Heck no!

Chinese billionaire entering the country? Where do you want the red carpet?

[GooooMarquette]

Again, what I said was:

However, I will say that the large "health care systems," many of which began as hospitals (or groups of them) and have morphed into, well, "health care systems," seem to be doing A-OK.

I stand by that, especially if Atrium is representative of most others of their size and scope. Otherwise, I  didn't say most of the stuff you and Ziggy claim I did, nor did I declare Atrium or any other healthcare system was "evil." And I provided data to back my discussion of executive pay at Atrium.

Absolutely, I will acknowledge that many hospitals, clinics and health care providers are doing less than OK. That surprises me, and saddens me, about the Philly hospital.

I hope that's enough to satisfy y'all. If not, well, that's A-OK, too.

Sorry, but no.

MedPAC and CMS analyze data hospital by hospital. And many of the struggling hospitals that operate in the red under Medicare are part of healthcare systems. The "healthcare system" language isn't used by MedPAC or CMS only because it isn't part of their analytical methodology. But the answer is the same: hospitals, even those that are part of large healthcare systems, are struggling to make ends meet in today's reimbursement climate.

Among other systems struggling, some prominent ones that have seen the press in recent years include Partners Healthcare (which includes Massachusetts General Hospital, Brigham and Women's Hospital, among others) and Cleveland Clinic (which has facilities in Ohio, Florida, Nevada and Abu Dhabi).

https://www.modernhealthcare.com/providers/partners-healthcare-reports-sharp-drop-operating-income ("The operating decline was driven by a 53% year-over-year decline on the provider side, and a more than doubled operating loss on the insurance side. Not-for-profit Partners said higher acuity and utilization of certain services on the provider side was offset by a shift toward a higher government payer mix and ballooning supply and labor expenses.")

https://www.cleveland.com/business/2019/02/cleveland-clinic-takes-financial-hit-in-2018.html ("CEO Dr. Tom Mihaljevic attributed that decline to the continued increase in the cost for providing care and decline in reimbursement rates.")

So with Partners Healthcare and Cleveland Clinic - two of the largest and most prominent healthcare systems in the US - struggling to consistently stay in the black, are you still convinced that, in general healthcare systems are A-OK?

Or is it possible, just possible, that they aren't so "A-OK" - that even large and highly successful healthcare systems often struggle just to stay in the black?

At this point, you can keep saying you're right if you want. But it isn't a good look keep insisting you're right despite facts to the contrary. And I have provided plenty of facts to the contrary.

[MU82]

Sorry, but no.

MedPAC and CMS analyze data hospital by hospital. And many of the struggling hospitals that operate in the red under Medicare are part of healthcare systems. The "healthcare system" language isn't used by MedPAC or CMS only because it isn't part of their analytical methodology. But the answer is the same: hospitals, even those that are part of large healthcare systems, are struggling to make ends meet in today's reimbursement climate.

Among other systems struggling, some prominent ones that have seen the press in recent years include Partners Healthcare (which includes Massachusetts General Hospital, Brigham and Women's Hospital, among others) and Cleveland Clinic (which has facilities in Ohio, Florida, Nevada and Abu Dhabi).

https://www.modernhealthcare.com/providers/partners-healthcare-reports-sharp-drop-operating-income ("The operating decline was driven by a 53% year-over-year decline on the provider side, and a more than doubled operating loss on the insurance side. Not-for-profit Partners said higher acuity and utilization of certain services on the provider side was offset by a shift toward a higher government payer mix and ballooning supply and labor expenses.")

https://www.cleveland.com/business/2019/02/cleveland-clinic-takes-financial-hit-in-2018.html ("CEO Dr. Tom Mihaljevic attributed that decline to the continued increase in the cost for providing care and decline in reimbursement rates.")

So with Partners Healthcare and Cleveland Clinic - two of the largest and most prominent healthcare systems in the US - struggling to consistently stay in the black, are you still convinced that, in general healthcare systems are A-OK?

Or is it possible, just possible, that they aren't so "A-OK" - that even large and highly successful healthcare systems often struggle just to stay in the black?

At this point, you can keep saying you're right if you want. But it isn't a good look keep insisting you're right despite facts to the contrary. And I have provided plenty of facts to the contrary.

OK, Goooooooooooooooo, thanks for all that info.

Respect you too much to argue with you. Have a good one.

[GooooMarquette]

OK, Goooooooooooooooo, thanks for all that info.

Respect you too much to argue with you. Have a good one.

The respect is mutual 82.

Stay safe, my friend.

[ZiggysFryBoy]

Their 2017 form 990.  Find it on guidestar.

Maybe they have some other entities where they pay the big bucks.

Nads, sorry was typing on my phone.  Should have said "Found it on guidestar." Meaning that was my source of info, not that yiu shiuld go verify for yourself.   Peace.

[MU82]

The respect is mutual 82.

Stay safe, my friend.

Back at ya.

And just FYI, I didn't blow off the data you sent me. I did look at it. I assumed that most large healthcare systems were in as good financial shape as Atrium, and apparently I shouldn't have.

Nads, sorry was typing on my phone.  Should have said "Found it on guidestar." Meaning that was my source of info, not that yiu shiuld go verify for yourself.   Peace.

No sweat. Stay well.