Armed Polite Society
Main Forums => The Roundtable => Topic started by: MillCreek on January 25, 2017, 12:23:51 PM
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I was reading an editorial letter this morning in the WSJ, calling for the closure of the VA system and giving the patients insurance for the civilian medical system. This makes me wonder how well the civilian healthcare system would cope with the influx of patients. I know that in the greater Seattle area, most of the primary care providers are already full up with patients and cannot accept new ones, and many of the hospitals are running at a pretty high census right now and sometimes do not have beds available.
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I think that is a pretty common state of affairs throughout the US. We put people on Choice and they still have an inordinate wait time, if they can get in at all. Another thing you are dealing with is the .gov, they are notoriously slow at paying bills and low balling all costs. That is what keeps some docs from accepting Medicare patients, I don't see any change with moving the 8 million or so Vets out into the community for care, in fact it may make things worse for those on Medicare as even more docs will fill their panels and won't accept more patients.
There are a lot of things that need to be done and just dropping the VA health care and moving into the community without a lot of planning and foresight would be disastrous for nearly every one who relies on some sort of subsidized health care, and even self payers IMO.
bob
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Wouldn't a lot of the VA medical facilities be taken over, and run by private enterprise?
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Wouldn't a lot of the VA medical facilities be taken over, and run by private enterprise?
I think the sticky wicket on that may be getting the state licenses/certificates of need that would allow a private facility to open. The local competitors may not want additional facilities to open that could cut into market share.
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I know that in the greater Seattle area, most of the primary care providers are already full up with patients and cannot accept new ones, and many of the hospitals are running at a pretty high census right now and sometimes do not have beds available.
Hmm... in economics, we could characterize that as a shortage:
(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fwww.colorado.edu%2FEconomics%2Fcourses%2Fecon2020%2FUnit4%2Fgifs%2Ffig410.gif&hash=f57c5a70608bd485187061fefa967558481501aa)
I wonder how ever could that be happening?
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I think the sticky wicket on that may be getting the state licenses/certificates of need that would allow a private facility to open. The local competitors may not want additional facilities to open that could cut into market share.
So the problem is government again?
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Healthcare is indeed very regulated, says the risk manager as he is filling out government paperwork for a service line state licensure application.
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I think the sticky wicket on that may be getting the state licenses/certificates of need that would allow a private facility to open. The local competitors may not want additional facilities to open that could cut into market share.
Where I live, we have two large private hospitals in one city (which recently merged, but continue to operate as two discrete campuses), two more, smaller private hospitals within about a ten (maybe fifteen) mile radius, and a regional veterans hospital right in the middle. I get much of my medical care at the VA. It's always jammed -- there are days when I may cruise the parking lot for twenty minutes before finding a parking space. If all the veterans who are currently seen there are suddenly dumped onto the private healthcare market, I don't think there would be any problem whatsoever getting a certificate of need for the hospital to stay in operation.
Whether or not it would meet the state's requirements and a private hospital is a different question ...
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So the problem is government again?
Yup. CoN laws need to die in a fire. They're directly contributing to the high cost of healthcare, as well as not being so good for the patients (http://reason.com/blog/2017/01/25/how-virginias-hospital-licensing-laws-co).
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Yup. CoN laws need to die in a fire. They're directly contributing to the high cost of healthcare, as well as not being so good for the patients.
FWIW, I'm quite familiar with the region referenced in the article. While the hospital itself should be allowed to determine what services it provides, there is a NICU just 6 miles away from Lewis Gale, at a larger and much more advanced hospital. Why didn't Lewis Gale transport her there? I'd say they are just as culpable by putting their own interests ahead of the mother's.
An ambulance could have had her at Roanoke Memorial (Now Carilion Clinic) in minutes.
Chris
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FWIW, I'm quite familiar with the region referenced in the article. While the hospital itself should be allowed to determine what services it provides, there is a NICU just 6 miles away from Lewis Gale, at a larger and much more advanced hospital. Why didn't Lewis Gale transport her there? I'd say they are just as culpable by putting their own interests ahead of the mother's.
An ambulance could have had her at Roanoke Memorial (Now Carilion Clinic) in minutes.
Chris
From the article, the ambulance that had the required neonatal equipment to keep the baby alive for the trip was on another call, 30 or more minutes in the other direction.
Additionally, this makes me extremely angry. Clearly Carilion and the state bear responsibility for this death. Yes, a close NICU is fine and women with high risk pregnancies ought to choose Carilion. But even low risk pregnancies end up with complications. Having a small NICU capable of dealing with lower likelihood events is wise.
But, of course, the state and Carilion don't really care about life, now do they?
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As makattak said, *the* ambulance that could provide this transport was on another call.
There are two main children's hospitals in my area. they both have NICU's as well as isolette equipped ambulances. I'm not sure about the one, but the other hospital has one neonatal ambulance on site 24/7. If that one goes out, there's a backup (as long as there's a second neonatal team in hospital) less than 30 minutes away. When the first team goes out, the backup unit moves to the hospital and the backup team gets called in if they're on call (and not already in house). There are also a couple of other hospitals with NICU's that don't have dedicated transport teams, but use the transport teams from the two children's hospitals.
As a backup to all of this, if the patient is too critical or too far away, the local air ambulance service can also transport these teams directly from either children's hospital (both have helipads) to wherever the patient is at, and fly them back directly to the children's hospital. And we can also do ground to one of the local airports for fixed wing transport to hospitals outside the helicopters range.
Yes, in the quoted article, Carillion does have sufficient NICU space to cover the region. But there are times when you need the NICU *now* and even though we have all the transport capability in our region, there are still instances where those patients need the capabilities of the NICU before the transport team even gets there. And the reality is that some babies, no matter what, are simply too fragile or too premature to survive, regardless of what care may be available. But I believe it's unconscionable to have EVERYONE that testifies say that "yes, adding a small (8 bed) NICU to our hospital is a good idea" but have the proposal rejected because the other competing hospital doesn't want to lose the exclusivity of having the only NICU in the region. Part of their testimony, in fact, was that "if Lewis-Gale were to have a NICU, patients would not choose our hospital" (paraphrased). THAT is not a sufficient reason to prevent another hospital from having a NICU.
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What article are you talking about? I haven't seen an article linked in any post in this thread and I have no idea what you're talking about. And what does natal urgent care have to do with closing VA hospitals?
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Yup. CoN laws need to die in a fire. They're directly contributing to the high cost of healthcare, as well as not being so good for the patients (http://reason.com/blog/2017/01/25/how-virginias-hospital-licensing-laws-co).
This one?
bob
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Privatize the VA and give veterans the option of the VA or their local Docs/Hospital.
I would love to stay with my Doctors that have treated me since Day One and have the VA pick the tab for what my private insurance doesn't cover.
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http://www.seattletimes.com/seattle-news/federal-hiring-freeze-leaves-570-jobs-open-at-local-va/
Maybe they will stop calling to pester me about the Seattle VA risk management director job.