10 ms·
After Appalachian hospitals merged, their ERs became much slower
- 2devnull 3y agoSeems ironic that Kaiser is banging on about the horrors of healthcare monopolies. Are they not themselves a giant healthcare monopoly that just happens to operate in a wealthier geographic area?
- dredmorbius 3y agoKFF (no longer "Kaiser Family Foundation") is organisationally independent of the Kaiser healthcare systems: Importantly, we are not affiliated with Kaiser Permanente, and we are not a foundation. <https://www.kff.org/about-us/ https://www.kff.org/about-us/>
- 2devnull 3y agoYes, heard it before. Find anyplace that KFF is critical of Kaiser the HMO. I can’t, but would love to be proven wrong.
- dredmorbius 3y agoSecond search result presently: <https://kffhealthnews.org/search/permanente https://kffhealthnews.org/search/permanente> Title: "Promising Better, Cheaper Care, Kaiser Permanente’s National Expansion Faces Wide Skepticism". <https://kffhealthnews.org/news/article/kaiser-permanente-national-expansion-risant-geisinger-skepticism/ https://kffhealthnews.org/news/article/kaiser-permanente-nat...> There are numerous others. HN values intellectually curious discussion, not ideological cliches. Basic familiarity with site "about" and search features is also strongly encouraged. <https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=by%3Adang%20intellectual%20curiosity%20ideological&sort=byDate&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...>
- 2devnull 3y agoThanks. Yeah I guess I was thinking more about the content/research/advocacy that they themselves produce. The article you link is their news aggregator (kff health news) reposting a Sacramento Bee news article. Anyway, I appreciate you taking the time to respond. My impression that KFF doesn’t produce research or advocate for policy that is contrary to Kaiser the HMO’s interest weakly persists, but I suppose that needn’t signal any specific conflicts of interest so much as hint at incentives and business model issues. If I understood KFF’s business model better (are they a think tank?) it might resolve my concern about their alignment with big healthcare interests in general and Kaiser permanente in particular.
- dredmorbius 3y agoIncentives are themselves powerful, whether explicit and overt or covert and/or incidental, so that's a fair gripe. Note too that it's not the question of whether or not KFF is or isn't biased, toward or away from, Kaiser Permanente or any of the health system's other arms and branches. (Kaiser operates in several states, I'm not sure whether or not those are independent entities, and the physician, hospital, and healthcare insurance functions are also, so far as I'm aware, at least somewhat autonomous.) Rather it was pursing the extremely weak rhetorical tactic of 1) assuming or implying that the entities are the same and 2) that a bias does exist. I'd not known the answer to either of those questions prior to seeing your original upstream comment, but it took less than a minute to answer both questions. Again, the spirit of HN is for substantive discussion, not casual meme-slinging. Not always attained by any stretch, but the site would be much better for it. It's not infrequent that I'll begin posting one argument here, research my points (even only casually), and ... substantively change my mind in the process. That's one of the chief values of online discussion IMO. And a good day is one in which I've learned something, so given my admission above, this was two good days, thanks.
- nojvek 3y agoThe 5 greedy systems of US healthcare. 1. AMA (American Medical Association) artificially controlling the number of medical graduates based on a quota. Every doctor starts of a huge debt, and many don't get to practice. No experienced doctors from other countries can practice here. 2. Hospitals (many owned by Private Equity) - Maximize profit / patient. Don't show prices, lots of outrageous billing for basic care like Ibuprofen and bandages. The bills keep on coming for months after care. 3. Doctors - Gotta pay those debts. No prices advertised, Inflated costs for basic care. Specialists are booked for months. 5. Insurance companies - Can only make max 20% on administration costs. Love the high prices and denying claims for whatever reason they can find. 3. The politicians - Make $$ from lobbying insurance companies and big providers. Employers sponsored health insurance means individual workers don't have same bargaining power. Essentially we are paying a fortune. ~5 trillion for healthcare. If we pooled all that money into a govt funded insurance pool, and removed artificial license quotas, market advertised prices, we'd have a much more efficient healthcare. The corporations know the individuals can't coordinate between themselves to take them out. They have captured the market. Instead we have a huge administrative bloat, gofundme pages, lowest mortality amongst the rich countries and a shit show.
- Rinzler89 3y agoHow did the government allow for healthcare to merge into a monopoly? They didn't allow Nvidia to buy ARM but they allow this?
- lotsofpulp 3y agoThe government even enforces a monopoly or duopoly in hospital healthcare: https://www.investopedia.com/terms/c/certificate-of-need.asp https://www.investopedia.com/terms/c/certificate-of-need.asp
- shigawire 3y agoBecause these are very localized to a certain geographic area?
- ceejayoz 3y agoNo, because they were permitted to violate the law by legislators. > In the six years since lawmakers in both states waived anti-monopoly laws... > Ballad Health was formed in 2018 after state officials approved the nation’s biggest hospital merger based on a so-called Certificate of Public Advantage, or COPA, agreement. COPAs have been used in about 10 hospital mergers over the past three decades, but none has involved as many hospitals as Ballad’s. > State lawmakers in Tennessee and Virginia waived federal anti-monopoly laws so rival hospital systems — Mountain States Health Alliance and Wellmont Health System — could merge into a single company with no competition. Ballad is now the only option for hospital care for most of about 1.1 million residents in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina.
- roughly 3y agoI'm sure it'll be different this time, though
- giantg2 3y agoThe government treats them sort of like a utility.
- 3y ago
- devilbunny 3y agoI wonder if anything else might have happened around 2020 to increase ER wait times due to lack of beds in the hospital? They might be awful scum; don't know. But ER's are very, very expensive places to keep patients waiting for a bed. The claim that nursing shortages in the hospital drove this is not implausible. And when nurses can make several times as much money doing travel nursing in big cities, how's a place like Bristol going to compete? They wouldn't have left their families for $10-20 more per hour; they left for four to five times the money per hour. Or even more. Rich, big cities absolutely used their financial means to make sure they had nurses. Where did they come from? Small, poor cities and rural areas. In peak COVID, there were nurses being offered $10k/week with free housing. A brutal schedule to match the pay, of course, but if you live in Bristol, a month away would pay for a year of college for a child.
- rpmisms 3y agoYou seem to think Bristol is still low-COL. It's on par with a typical metro now.
- geraldwhen 3y agoI’m looking at house prices, and it is not.
- rpmisms 3y agoTypical metro, not California metro.
- forgetfreeman 3y agoWelcome to the rest of the country. It's pretty nice here. Just, um, try not to get sick or anything.
- rpmisms 3y agoPretty much, yeah.
- 3y ago
- beezlebroxxxxxx 3y agoGreed has taken big notice of an ageing population, in need of more medical interventions or long term care as they age, ready to be sucked dry of every little $ to the cent. The callousness of a system like this, it's tendency to rob people of their dignity, and the seeming indifference of any people or organizations with the power or capacity to intervene, is profoundly depressing. A system that holds healthcare behind a tollbooth, equating quality of care with wealth, implying only the rich deserve quality care and the nonrich deserve whatever they can get, is inhumane and plain mean.
- Terr_ 3y ago> Greed has taken big notice of an ageing population Pet theory: That's also related to the burst of autonomous-vehicle investment over the last decade: Investors spurred by the idea that the baby-boom generation will simultaneously (A) be unable to drive themselves and (B) will have enough wealth to afford fancy cars that cater to that need. I don't think related companies have to hit that opportunity-window to be profitable, but I think it factored into when/why some of them were founded or pivoted.
- nox101 3y agoI don't want to defend medical care in the USA. I lived in a different country for a long time and loved the access it provided though not every thing was good. But, even there, Japan, they are struggling to provide the care needed. I'm curious how you would resolve the limited supply (# of doctors) to the infinite demand (population of people needing medical attention)
- InitialLastName 3y agoYou could remove artificial limits on the numbers of medical school and residency slots, but then doctors would get competition.
- NBJack 3y agoYup, this is basically the best starting point. It is just a different kind of monopoly, which also often gives the illusion of achieving an elite, illustrious lifestyle when the reality is that many physicians start in serious debt.
- blakesterz 3y agoIn 2022, Ballad reported a median ER time for admitted patients of about six hours. In 2023, it reported the same statistic at seven hours and 40 minutes. In the latest report, ER time for admitted patients had reached 10 hours and 45 minutes.
- onlyrealcuzzo 3y agoI imagine ER admission times were steadily increasing prior to the monopoly. How did the rate of increase change?
- choilive 3y agoIn addition, depending on how you model ER admissions using queueing theory - the wait times very quickly goes exponential with even relatively small changes.
- destroy-2A 3y agoI imagine all the signs about don’t abuse the staff and incidents of abuse against hospital workers went up at the same rate as the wait times. Abusing the staff is wrong but you have people that have come there because they think they are about to die without attention, they really don’t have a choice
- roenxi 3y agoThe fact that this is even a point of investigation is very frustrating. Wait times at local restaurants in my area are basically constant and will remain so, because if there is an observable queue, someone opens a new restaurant or an existing one puts on more staff and finds space for more tables. If people were permitted pay directly for emergency visits, and new hospitals allowed to open then it would be ridiculous for there to be a general problem with trending wait times. Someone would add more emergency capacity somehow. That isn't even in conflict with keeping a public system either, there can still be a public system. Just let people who can afford their own emergency care fund their won care. The problem here is precisely that deliberative bodies trying to work out how much emergency care is required instead of creating an easily-joinable class of people who benefit financially from providing care and leaving decisions up to them. That works well for almost literally every service out there and there is no reason to think it would fail for emergency healthcare. These people attending clearly have hours to shop around.
- rpmisms 3y agoOh look, it's my neighborhood healthcare system. Kinda weird to see the tri-cities and Neal on HN. On topic: They're literally the worst, nothing here is an exaggeration, Ballad is utter dogshit. It's so bad that the Tennessee legislature, famously fans of non-interference, are considering breaking them up.
- senorrib 3y agoWasn’t the monopoly interference in the first place?
- rpmisms 3y agoThe hospitals would have shut down without it, so it was rubber-stamped as "let's not bail out the hospitals". If the monopoly functioned, there would be no issue.
- fuzzfactor 3y ago>If the monopoly functioned, there would be no issue. So it was an experiment. Anything like politicians without professional health background using their constituents as medical test subjects?
- peteradio 3y agoLook buddy if you don't like your freedom panels then you can giiiiiiiiiiiit out.
- rpmisms 3y agoNo, Tennessee does not practice deficit spending. It was a calculated move to avoid raising taxes, and a gamble that did not pay off. > Anything like politicians without professional health background using their constituents as medical test subjects? This is bad faith.
- fuzzfactor 3y ago
- roughly 3y agoBarbara Kingsolver's book "Demon Copperhead" is a gut punch of a look at the degree to which Appalachia has gotten fucked over over the years, and is also just an absolutely fantastic novel with some of the most beautiful writing I've read in years: https://bookshop.org/p/books/demon-copperhead-barbara-kingsolver/18506689 https://bookshop.org/p/books/demon-copperhead-barbara-kingso...
- dhfbshfbu4u3 3y agoExcellent rec. It’s a great book.
- reustle 3y agoAnd if you’re into the topic, I highly recommend Peter Santenello’s interview series on it https://youtube.com/playlist?list=PLEyPgwIPkHo5If6xyrkr-s2I6yz23o0av&si=VI20Jzmw2HwuQcXm https://youtube.com/playlist?list=PLEyPgwIPkHo5If6xyrkr-s2I6...
- diogenescynic 3y agoSutter Health is my local hospital monopoly. They're the only reason that Sacramento is the most expensive place in the country to have a baby. And the quality isn't exactly high. I know someone who just had knee replacement surgery and they were sent home a few hours after their surgery. When my grandpa had the same surgery in the 90s, they had him stay for a few days to recover. Now they just want to churn and burn their 'customers'. In addition, my wife after giving birth was only allowed to stay the bare minimum. It's shockingly gross how we've commoditized access to healthcare into this assembly line style racket. Contrast to Europe, when I hit my head on a train and needed stitched, I got a free ambulance to their ER where two nurses and a doctor immediately stitched me up for less than 40 EUR and was given world class care. We're doing something wrong in America when we pay the most extreme prices for the most basic care. We're getting gouged so executives can line their pockets. We should be rioting but we all just accept it. And it's not like Obamacare or Biden have done a single thing to change things. Obamacare just forced everyone to buy insurance... it didn't really change the fact that when you go to use it you get crappy care. And even when you go to a place like UCSF, the quality of care isn't that great. They put my wife's IUD in wrong and we ended up with a second kid. Healthcare in America is shit quality.
- datavirtue 3y agoOn top of the highway robbery of private health insurance we have a defacto single payer public healthcare system for retirees and those on public assistance that is the government's largest expense, currently sitting in the #2 spot (a major issue that keeps getting kicked down the road), after that you have interest on the debt that is borrowed to fund everything, and then defense (and no, defense can't be cut, don't even go there). We are heading for a surprise failed bond auction (where private investors cause a government shutdown because they refuse to purchase bonds). Biden is going after a major elephant in the room: the sprawling UnitedHealth monopoly. And Trump took the first stab at the other sprawling healthcare monopoly: regional hospitals. If the people do not start voting in moderate statesman and serious legislators then all their petty dumb ass concerns are going to get crushed out of existence in one fell swoop of mandatory fascist-socialism...if they are lucky. Honestly, I can't venture to guess the fallout of a bond auction hiccup. All I know is that it will involve pain for everyone in the world.
- wcedmisten 3y agoI was thinking it might be interesting to show a map of regions to the closest hospital, and color code it by the operator, like ballad health = red, banner health = green, etc. I'll see if OpenStreetMap has this data available
- lnxg33k1 3y agoA (non)friendly reminder to libertarians that a society where "It's a private company, they can do what they want", is against the best interests of society
- trentnix 3y agoGovernment can do what it wants, and at a perpetual loss. At least the private company has to make ends meet.
- hengistbury 3y agoGovernments still have budgets. At the end of the day it's just money in, money out, except private healthcare has someone siphoning money in the middle.
- skidd0 3y agoYou might not have realized how this monopoly was granted. It wasn't a free market decision, it was state sanctioned.
- saalweachter 3y agoThe state forced these hospitals to merge over the objection of their owners?
- nkrisc 3y agoA state-sanctioned monopoly means the state did not interfere in preventing the monopoly in the first place.
- akira2501 3y agoThat almost makes it sound like "the state" did it for fun and that money wasn't somehow involved.
- justrealist 3y agoThere's nothing even remotely libertarian about US medical care. Find another strawman to attack.
- shrubble 3y agoThe EMTALA law may have been well-meaning but it has been abused by people who are there for non-ER care: https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act https://www.cms.gov/medicare/regulations-guidance/legislatio... Even 20 years ago, I experienced this directly as someone who paid for their ER care while others came in for non-ER care, and knowing they would not have to ultimately pay for the care they received.
- jtdev 3y ago[dead]
- ttimez 3y ago[dead]
- _k2ji 3y agoThe roughest thing that Ballad has done is take the brand new NICU from Holston Valley in Kingsport that was opened in 2016 [1], shut it down and move it 30-45 minutes further away to Johnson City in 2019 [2]. Granted we know drive times are further up here, and helicopters are faster, but that could be precious minutes for a NICU baby. [1] https://www.timesnews.net/living/wellness/holston-valley-unveils-new-2-5-million-nicu/article_f6d88e4b-98ab-5281-8194-7bb05ca58f77.html https://www.timesnews.net/living/wellness/holston-valley-unv... [2] https://www.balladhealth.org/saving-lives/nicu-updates https://www.balladhealth.org/saving-lives/nicu-updates
- mjfl 3y agoHospital costs are rising which is putting them out of business, which causes mergers and takeovers by organizations that specialize in extracting profit out of hospital services. These organizations do this by reducing costs by lowering nursing staff numbers to like 20% of what they were before, which pretty directly leads to lower quality service. The cost increases in the medical industry are quickly making the whole system nearly untenable. We could see a system collapse in the near future. One way of mitigating this is providing the same services outside of a hospital- for example the cardiologists leaving the hospital and starting a private practice. This leads to reduced overhead and maintains tenability of the whole system.
- wolverine876 3y ago> Hospital costs are rising which is putting them out of business Why are they rising so much?
- mschuster91 3y agoHere in Germany, we have similar problems. There's a combination of causes... and probably they're also applicable for the US: - rising costs of energy (electricity, gas) - decades of underfunding of building construction and maintenance, leading to a massive backlog of issues - same for IT - modern machinery (ultrasounds, MRTs, CTs) costs immense amounts of money - general staff shortages that need to be filled via expensive temp-staffing agencies on one side and cause wage rises for those employees that remain - as a result of that, beds have to be marked as "inoperative" and they don't generate income, whereas the expenses keep piling up (there finally are reform plans to pay hospitals for providing beds, but it's a ... let's say toxic minefield) - rising costs of administrative bullshit and legal compliance - insurances being utterly ridiculous regarding payments, both In the US, I'd add "more and more people unable to pay", which leads to the cost of care for these people being redistributed to everyone else.
- mschuster91 3y ago> One way of mitigating this is providing the same services outside of a hospital- for example the cardiologists leaving the hospital and starting a private practice Bad idea. If anything, what you need in a hospital is short paths to transfer people from one specialist department to another (or, should the patient be too unstable to transport, to call up the specialists to get down to ER), and you need integrated IT systems to not waste time with data transfer.
- Sparkyte 3y agoProbably trying to sell fast lanes. Not retiring in US with this bs.