The Hospital's financial picture: murky at best

Ackpeep, they hired a bunch of new administrators and other upper crust management types to fill the former patient rooms. I know they hired a couple of new people for fund raising.

There are a whole bunch of problems at NCH and health care in general. Health care has almost no fixed pricing for anything. Facilities often buy a kit for a particular procedure and then bill it out as individual items for a much higher price than a kit would cost. When I was a kid, I was born at NCH, I and many others I know had many of lifes normal problems related to health care. I had my share of stitches, colds, flues, and the like. When it was more serious than that you went to a specialist at a bigger hospital. More often than not serious injury or illness required a medflight. Judging from the ones I hear coming in it is still that way. You know it is possible to offer too high a level of services and care to be profitable. They keep trying to offer more and more services and that could be part of the problem. I and all of my classmates survived our childhoods when the hospital offered basic services and minor surgery. Yes, some people died that may have been saved if our little hospital had the facilities and staffing of MGH. Unfortunately, we do not and never will. It is still a good facility and they can refer patients to the appropriate  doctor and facility to handle things that are more serious. Nothing against the current doctors, staff, or facility, but, there is nothing wrong with stabilize and mobilize. Most would prefer to be treated by someone that deals with your medical problem everyday of their lives.

Just my thoughts.

Bob's question is a fair and direct one.  It certainly applies to the hospital.  

What level of management does that organization, or any Nantucket organization need now that it is part of a national group?  The problem of the hospital is the same as the banks, the gas, Marine Home, phone, trash, or power.  In the last twenty years, we have sold or outsourced almost all of those organizations to off-island groups.  In return, those that sold got rich with a one time cash bump.  But now, almost all of those back-office jobs have disappeared to Fitchburg or Bangalore.  

We can argue about causes.  It could come from the island's desire to grow at a fantastic rate.  It could come from the national financial bias that favored consolidation.  However, you can't argue that a whole bunch of valuable jobs are no longer on island.

I think the loss of local management means that those organization will function worse than they did before.  Nantucket is a peculiar environment with even more peculiar citizens.  When you remove locals from those management positions, you remove all of that useful knowledge.  

At the same time, there has always been an instinct, in this and in every community, to feather your own nest.  Inefficiencies have benefited many on island.  Any of those groups, from the banks to the power company, probably had a great deal of self dealing.  

Now, there is only one business in town that has nice indoor work, no heaving lifting and that is the town.  The town, whether at the dump, in the planning department, or in the schools, have the recession proof jobs.  Since we are still in a devil of a recession and people are worried about scallop and peanut butter sandwiches this winter, the attention of the voters should be on the town.  

So, there has been a bunch of self-dealing by people in town government.  And, as we cut the size of town government down to fit the new, smaller island, Matt's question is fair.  Do you cut nurses or managers?  Do you cut teachers or vice-principals?

In many communities, off-island, they believe that they can get ANYBODY to teach, but can't get any managers, so they cut the teachers and give the vice-principal a boost.  It's thinking like a factory.  

Let's put it another way:  Could we cut some hospital administrators and revive meals on wheels?  Or should we pay the administrators more and hope, with better pay and more "Incentive" they could find someone to do it for free?

B

I'm sorry my example offended.  I assumed the analogy appropriate, especially since you were comparing managers in a town department to those in the hospital.  I found the question Bob posed as to who bears the brunt of potential layoffs, grunts or upper level managers, valid and worthy of consideration.  By posing it as a theoretical, and removing it from the current emotional situation surely swirling at NCH, I hoped to encourage thoughtful, intelligent discussion.

Again, my intent truly was not to hi-jack this thread, and I apologize to anyone who felt I was attempting to do so.  I'll steer clear. 

Yack on.

Matt   

Matt, I'm getting more than a little tired of your thread hijacking to talk about town finances all the time. This is the second time this week. Please stay on topic. If you want to start a new thread, do so. I should not have to constantly remind you to post on topic and not spam people. 

Edited by YACK host. Off topic. 

Interesting question, Bob. 

I'm wondering how you would feel if someone suggested that the NPD does not need any management. After all, we have a town manager. Let's fire the chief and she can make all of the decisions for the NFD.

Setting aside the fact that managing a fire department or a hospital is a full-time job, and the Town manager as well as the Partners Health Care peeps already have full time jobs, so it's unlikely they could take on more, I'm relatively certain that your answer would be that its important for any organization to have someone who knows the details and understands the challenges day-to-day.

You can't run a fire department or a hospital by remote control.  

Why does this hospital need a full set of upper level executives...?....They are a Mass General sub-station (or whatever it is called) so why incure the costs of upper level management and not just utilize the Mass General Bosses...?... The working staff (Docs, Nurses, Fund Raisers, Clerical, etc.) are all hard workers, but they are the ones who took the beatings during the layoffs... yet the higher paid Management (who has since left for a hospital for somewhere else) took no cuts anyone knew about...... Does NCH really need its own high paid management team...?

I remember when the Pops concert raised $1million that went toward something, equipment etc, toward the new ER etc. Then a few years ago I heard that it just covered non-pays, now the non-pays are triple that.  There certainly seems to be a change in the last several years!  I bet business is down quite a bit since approx 5,000 year round people have left the island, and those were people making good money who could afford insurance.  Now they are not here to offset the non-pays.  Many of the non-pays know they cant be refused, so why pay?

   And Ken there is a gap between being able to afford state insurance and qualifying for mass health, so some non-pays might be in there.  I dont have insurance and got some bloodwork done and it was 6 months before I got a bill!  I made sure they didnt have any old insurance on there that would delay things and said just send me the bill.  It took 6 months!  How many businesses would survive doing that?  Is it that disorganized? Plus, I got a 25% discount for paying quick!  Quick, after the 6 months of delay.  There was no system in place for me to just pay on the spot.  The entire system has gotten so far away from people paying for any medical services whatsoever that I couldnt even pay for it myself, not until it went through 6 months of administrative "process".

Peep, I was also happy to see the I & M commit journalism both this week and last week.  Jason and the rest of the staff deserve a hat tip for their work.  The Old Girl is going to be changing in the next few years into something we cant' recognize right now, but many of the feature articles this summer show a good instinct.  

Hi All - If I may quote from the article in the I&M ...

"Moreover, Collins said that an increasing “free care” population means islanders without insurance are incurring about $2.86 million in yearly bad debt on which the hospital is struggling to collect, amounting to 11 percent of its roughly $26 million in yearly revenues."

So on one hand the customer base is shrinking, but apparently the "free care" population is not.

Reading slightly between the lines, these "free care" people must be undocumented people here on our island, since we know that ALL Massachusetts residents are now mandantorily insured.

This brings home the fact that if YOU are saving money by hiring undocumented people, you need to think about the added taxes and other fees these undocumented folks may be costing all of us.

Kenny B., in Englewood, FL not far from Englewood Community Hospital

I thought the Inky article was exceptional.  Great in-depth reporting, and full of critically important information we all need to know, about the hospital and doctors, as well.  I hate to think that all we'll have at NCH is the emergency care facility and a heliport to get peeps needing attention off this island.

Interestingly, there was no mention in the story that the hospital, although it laid off 16 or 17 people at the first of this year (I heard it had been planned for December '09, but that was determined to be a bad time of year to do such a thing), has hired about 40 new employees since then.  At least that's the word I've heard from the inside.

Anywho, our hospital's "murky at best" future is a great way to put it.

'Peep