Do you regularly check your EOB (Explanation of Benefits) charges on Medicare/Medicaid or other insurance billings? Why should you bother? Oh, you think it must be absolutely, without a doubt, correct all the time. An innocuous “needle insertion” charge of $5 may be easily missed, even when the procedure wasn’t done but there’s more here than meets the eye, initially.
Physicians are very fastidious about those things, aren’t they? Think again. Your charges may be emblematic of a much larger and much more serious issue; hospital competition and hospital closings.
Medicine has become a huge business where national medical corporations are gobbling up hospitals all over the United States and turning them into one large network. Insurers are giving auditors the power to cause fear in the hearts of physicians who refuse to accept a medical mandate from an unlicensed and unqualified non-medical person.
The auditors have unreasonable power and when in disagreement with physicians, can begin a terrifying spiral of legal expenses incurred to maintain a medical license. And all because the auditor, who works on commission and receives a percentage of the funds recovered, can engage in this fear-mongering action.
The tip of the iceberg is here, but, like the crew of the Titanic, it’s hidden from view. Reimbursement is the grease that keeps the medical wheels working, but it also smooths the way for corporate decisions that may not be in the best interest of patients. Buying up or closing hospitals is now the name of the game.
The Death of Community Hospitals
Community hospitals are dying because of consolidation and corporate planning and leaving patients will little to no choices. The seriousness of this die-off can be seen in maps provided by research groups and they point to the most devastation in the South with Texas (14 since 2010) leading the pack, followed by Tennessee (8 since 2010), Georgia (6 closures), and Alabama, Mississippi and North Carolina with 5 hospitals each closed in the past years. Feels like a community-hospital extinction, doesn’t it?
Cancer patients have a particularly difficult problem when rural hospitals close. The result was meticulously outlined in “Have Cancer, Must Travel: Patients Left in Lurch After Hospital Closes.” Having to drive an hour to the next open chemotherapy facility, after her local hospital in Kansas closed, meant this patient had to skip her morphine to drive safely. For added insurance, she brought along her 76-year-old friend to drive her back after her weekly treatment.
How noticeable is the creeping closing of community hospitals and the resultant effect on cancer patients, in particular, who require weekly care? The Centers for Disease Control & Prevention, in a press release, noted “… persons living in nonmetropolitan (rural or urban) areas in the United States have higher death rates from all cancers combined than persons living in metropolitan areas.” They compared the rates as “180 deaths per 100,000 people in rural counties, compared with 158 deaths per 100,000 in highly populated metropolitan.” It may seem like a small number of deaths between the two, but if your loved one lived in a rural community, how would you feel?
What’s happening to the rural medical safety net for those living with serious illnesses? The picture painted by groups surveying the medical landscape isn’t reassuring. In one report, the seriousness of the consequences is starkly outlined in an article headline, “112 Rural Hospital Closures: January 2010 — Present.”
Is the Hospital “Closed” or Not?
The description of a “closed hospital,” is almost ludicrous when you read how it is outlined. “Note that a facility that closed its inpatient unit but continued to provide emergency and outpatient services at the same physical location would be considered a “closed hospital” that “converted” to offer other health services. Likewise, a facility that dramatically scaled back its inpatient services (e.g. from 70 beds to 2) would be considered “open” because it continues to provide inpatient services (albeit in a vastly reduced manner).”
Sometimes, these hospitals are converting themselves into “medical malls” to turn their finances around in a corporate make-over of medical “care” as we will know it. Whether this is seen as “convenience” or an effort to curb competition is left to the mind of the reader.
The Mayo Clinic, in Rochester, MN, when I visited it a few decades ago, was a true mall in many senses of the word and included a hairdresser, newspaper stand and blood-draw amphitheater all in one place, including their capacious underground “subway” tunnels that connected the building to the parking structure. Yes, they referred to these tunnels as subways. And, yes, they owned all five hospitals in town.
The Largest Hospital Chains
What are the largest hospital chains and how many hospitals did they own in 2016? Here’s the breakdown:
Hospital Corporation of America: 169 Community Health Systems: 159 Ascension Health: 141 Catholic Health Initiatives: 103 Trinity: 92 Tenet Healthcare: 79 LifePoint: 72 Baylor, Scott & White: 48 Adventist Health Systems: 46 Prime Healthcare Services: 43 Dignity Health: 40 Kaiser Permanente: 38
Quorum Health: 38 Providence Health & Services: 34 Banner Health: 29 Universal Health Services: 25 Sutter Health: 24
Obviously, things have changed since 2016 with new players coming onto the field and cutting out the smaller ones in the process. In a 2017 survey of a hospital system, Statista outlined them this way:
Hospital Corp. of America — 174
USVA — 143
Community Health Systems — 119
Ascension Health — 78
Tenet Healthcare Corp. — 59
LifePoint Hospitals — 45
Trinity Health — 44
Prime Healthcare Services — 42
Providence Health & Services — 41
One system not listed, Northwell Health, in 2019 was the largest healthcare provider and employer in New York State with 68,000 employees. The corporation has 28 hospitals and 700 outpatient facilities.
Why are rural hospitals closing? The insurance reimbursement bean counters look at four things; insufficient patient populations, high rates of uninsured patients, dwindling cash flow and physician shortages, according to Dr. George Pink of the North Carolina Rural Research and Policy Analysis Center. The heartland of America, therefore, will be a wasteland for medical practice and, as it stood when he made a presentation in 2017, there will be some areas where no hospitals exist.
The populations most at risk will be those “who are unemployed, lack transportation or suffer from mobility limitations due to conditions like obesity, diabetes and tobacco use.” These rural residents comprise the poor, the elderly and those with chronic health conditions.
They hold the health of Americans in the balance and the scales appear to be tipping against those who have few voices to speak for them as shown; the poor, the elderly and chronically ill. What do we do about it? Look inward and you decide.