Over-Regulation of Hospitals?? Anyone else think so?

[WashingtonBay]

My opinion below :)

Capital Medical Center can offer elective angioplasties

Hospital: Capital Medical Center can expand heart procedures if conditions are met

ROLF BOONE; The Olympian | • Published October 24, 2009

Capital Medical Center won the right to offer a heart procedure in non-emergency situations Friday, ending a process in which it previously had to send patients to Providence St. Peter Hospital or another hospital for the procedure.

Barring an appeal of the state Department of Health’s decision, Capital Medical Center could begin offering elective angioplasties to patients as early as next month, said Steven Saxe, director of health professions and facilities for the DOH.

For years, doctors at Capital Medical Center have been performing angioplasties only on an emergency basis. This year, hospital officials submitted a certificate-of-need request to the agency in an effort to offer the procedure as an elective procedure. St. Peter, which is a nonprofit, opposed that application on several grounds, saying that it would result in an unnecessary duplication of medical services and costs in the area and take away funds used by the hospital for charity care...

More: Capital Medical Center can offer elective angioplasties - South Sound - The Olympian - Olympia, Washington (http://www.theolympian.com/southsound/story/1013039.html)


I was surprised to read this in our Saturday paper. By way of background, we have two hospitals in my area... St. Peters, and Capital.

And I had NO IDEA there were regulatory restrictions on these hospitals on what procedures they could offer. In effect, it seems St. Peters had an enforced monopoly on angioplasties. And they argued to prevent Capital from being able to provide them, not based on skill or patient safety, but because they didn't want the competition. It sounds altruistic and all, because they use the profit they make doing angioplasties to subsidize their charity work. Which is sweet and everything, unless of course, you're the angioplasty customer, or rather, that fat insurance company who will have to pay the bill. :rolleyes:

I'd just like to know, what would our medical costs be, if there was anything like a natural free market. It's so messed up now, there are whole layers of 'messed up' I didn't even know existed.

[mare]

The costs in some cases would go up.

In order to provide some specific services, the facility would have to have not only the equipment to perform, say, a procedure and the specially trained staff to perform the procedure, but often have specific other equipment and staff to provide support and to manage adverse effects common to said procedure.

These requirements are not only driven by our federal or state governments, but also by insurors of hospitals (in order to cover a hospital or clinic for liability) and by specialists also want/need to practice in the best prepared setting for optimal outcomes and safety of their patients.

That is why the industry has hospitals with different classifications. Regional means one thing, a hospital designated Critical Access means another, a City or County hospital, or a Women and Children's hospital each meet different criteria and assure that they can do what they offer. That's why some hospitals will market themselves as an areas "premier cancer treatment center" or "leading heart diagnostic center."

Everything is regulated and documented. The equipment and proof of standards of maintenance, the training of, and hours of availability, of specifically trained docs and support persons. In some cases the training of housekeeping (in hospitals that have done what they need to in order to treat really infectious diseases and lots of them).

Incredible.

[WashingtonBay]

But evidently they have been doing them in cases of emergency, so I'd think then, they have the equipment and training to do them, they just haven't been 'allowed' to do routine cases.

[mare]

Maybe (not knowing the facility I can't say for certain), but it sounds like they may have been able to do them in an emergency with the understanding that it had to be necessary in order to stabilize the patient appropiately with the certainty that the patient would be transported to the "right" facility as soon as s/he was stabilized.

[mare]

I can give an example of a Critical Access hospital I worked in a few years ago in a remote area. Not permitted by regulation to care for patients on respirators. During the West Nile Virus outbreak we had, we had two patients needing that support. Got both stable and case managers were busy looking for other hospitals (appropriately classified) to take them. Found a place for one. No room anywhere in the region for the other. So in that case he could stay put and the staff stepped up, learned a lot more about providing care to a person with this need and it all turned out okay.

The case managers wrote volumes of documentation to prove the respirator was first necessary and second that another hospital could not be found before the small hospital was reimbursed for this person's care.

[WashingtonBay]

You're probably right that it was tightly restricted. It just struck me as odd that there would be argument ~against~ a facility who wanted to do a procedure being allowed to do it if they are willing and able to do it. It didn't seem to be a safety issue, it was a competition issue.

And my instinct is, competition = good. :)

[mare]

I agree with your "competition = good."

Since they submitted a "certificate of need" I will hazard to guess that prior to this there was not the number of patients in the area to support the subsidizing of two hospitals to provide the same service, the one applying did not have all there requirements filled/completed, and the hospital who is applying to now perform the procedure thinks they can make more money than it will cost them.

And, yes, the government does subsidize the purchase of equipment, training, and probably a whole lot more that I'm not aware of in one way or another.

IMO, we've had a form of "government health care" for decades.

[WashingtonBay]

Thanks for the info on how it all works :), I didn't know a thing about it, and what I'd learned so far didn't make a whole lot of sense.

[mare]

Thanks for the info on how it all works :), I didn't know a thing about it, and what I'd learned so far didn't make a whole lot of sense.

Heck, I'm afraid it doesn't make real sense to those trying to keep the places open either, unfortunately.

[natisha]

We've had one hospital in this area forever. Another wanted to build one on the other side of the county. Hospital #1 fought it for years. Now #2 is near completion.
The result from a staffing point of view is #1 has improved their staff:patient ratio & slightly increased wages to try to keep staff. I worked at #1 for 10 years & they were brutal to staff.
All hospitals follow regulations but the competition has improved how they treat staff. Don't be fooled by nonprofit status. #1 is nonprofit & is owned by a couple of guys who are millionaires. Nonprofit means that there are not share holders, if I'm not mistaken.
I think it should be up to the hospital to decide if they can provide specific services or not.

[WashingtonBay]

In our local case... 'nonprofit' means Catholic.

And on your last... I agree, and didn't even know it wasn't that way!

[JackieB]

I heard an interesting news report on the radio the other day. It reported that a study determined that non-profits do not provide more indigent care overall (one of the arguments for non-profit hospitals) than do for-profit hospitals. This was based on a study of the hospitals in the Chicago area. Yet non-profits are exempted from paying taxes.

Just kind of interesting.

[Ragnar Danneskjold]

[...]Nonprofit means that there are not share holders, if I'm not mistaken.

Sortof, yes... "Nonprofit"-- or more accurately "Not-for-profit" doesn't mean that there is no profit (quite the opposite) but only that any retained earnings remain untaxed so long as they are reinvested for the benefit of the organization. They must operate at a "profit" just like anybody else (revenues must exceed expenses, or it's closin' time) it's merely what's done with the money that changes. It isn't distributed out to owners or partners, at least not directly.

I think it should be up to the hospital to decide if they can provide specific services or not.

Agreed.

[Ragnar Danneskjold]

[...]

And I had NO IDEA there were regulatory restrictions on these hospitals on what procedures they could offer. [...]


I don't think that there is even one problem we face today, on any level be it healthcare, the economy, education... pick an issue... I don't think there is even one that doesn't have as the core of the problem a governent regulation gone wrong.

[Reinmaker]

Sortof, yes... "Nonprofit"-- or more accurately "Not-for-profit" doesn't mean that there is no profit (quite the opposite) but only that any retained earnings remain untaxed so long as they are reinvested for the benefit of the organization. They must operate at a "profit" just like anybody else (revenues must exceed expenses, or it's closin' time) it's merely what's done with the money that changes. It isn't distributed out to owners or partners, at least not directly.



Agreed.

But it sure is easier to operate in the black when you are getting government grants. :)

[Remali]

Worked at a Catholic hospital for 5 years.... Also worked at a couple non-Catholic Hospitals too.
Of course it was only one Catholic Hospital out of many.....but I hope to NEVER work at another Catholic Hospital like that one again.

And some regulation is not a bad thing..... some hospitals simply do not have the specialists or the equipment to do certain procedures.....