Category: Hospitals

Lack of Transparency (and Bribes) Nearly Allowed Hospital to Commit Highway Robbery

googlemapsNear my old office just off U.S. Highway 75 in Dallas sits a hospital that was originally built by physicians. It is close to a hospital medical district, known as Medical City. Forest Park Medical Center was part of a small chain of investor-owned, for-profit hospitals. They are now bankrupt and have been sold off to bigger hospital systems.

Significant Drop in Health Facilities Construction in October

Census2Construction of health facilities slowed in October, while other construction increased a little. Overall, health facilities construction starts declined 3.1 percent, versus an increase of 0.7 percent for other construction. Health facilities construction accounted for almost 6 percent of non-residential construction starts. However, while both private and public health facilities construction both declined, there was divergence between private and public non-health construction.

Construction of private health facilities dropped 3.3 percent, versus a drop of 2.1 percent for public health facilities. Private health facilities construction starts accounted for almost 8 percent of private nonresidential construction starts. Construction of private non-health facilities declined by 2.0 percent, while construction of public non-health facilities increased 2.9 percent. It looks like the government has finally pulled back spending on public and VA hospitals.

(See Table I below the fold.)

Divergence in Private Versus Public Health Facilities Construction Continues in September

Census2Construction of health facilities slowed in September, along with other construction. Overall, health facilities construction starts declined 0.3 percent in September, versus a drop of 0.4 percent for other construction. Health facilities construction accounted for 6 percent of non-residential construction starts. However, the divergence between private and public continued.

Construction of private health facilities dropped 1.0 percent, versus a drop of 0.2 percent for other private construction. Private health facilities construction starts accounted for almost 8 percent of private nonresidential construction starts. Construction of public health facilities increased a whopping 2.4 percent, versus a drop of 1.0 percent for other public construction. Is this what they mean by “infrastructure” spending – broken bridges and roads, while more VA and county hospitals spring up?

(See Table I below the fold.)

Health Facilities Construction Growth Up Amidst General Decline in August

Census2Construction of health facilities significantly outpaced other construction in August. Overall, health facilities construction starts increased 1.2 percent in August, versus a drop of 0.8 percent for other construction. Further, both private and public health facilities construction grew.

Construction of private health facilities grew 0.6 percent, versus a drop of 0.4 percent for other private construction. Construction of public health facilities increased a whopping 3.6 percent, versus a drop of 2.2 percent for other public construction. Is this what they mean by “infrastructure” spending – broken bridges and roads, while more VA and county hospitals spring up?

See Table I Below the fold:

Significant Divergence in Private Vs. Public Health Facilities Construction in July

Census2The divergence between private and public health facilities construction continued in July. Overall, health facilities construction starts increased 0.3 percent in July, versus zero for other construction. However, there was a significant difference between the private and public segments.

Construction of private health facilities dropped 0.3 percent, versus an increase of 1.0 percent for other private construction. Construction of public health facilities increased a whopping 2.5 percent, versus a drop of 3.2 percent for other public construction (Table I).

Is this what they mean by “infrastructure” spending – broken bridges and roads, while more VA and county hospitals spring up?

Health Construction Shrinks Twice As Fast As Other Construction in June

Census2The see-saw in health facilities construction continues. Health construction starts dropped 1.4 percent in June, versus a drop of 0.6 percent for other construction (Table I). However, there was a significant difference between the private and public segments.

TI

Health Facilities Exceed Other Construction in May

Census2April’s drop in health facilities starts looks to have been idiosyncratic. Health facilities exceeded other construction in May, as in March and February. While construction overall dropped at a seasonally adjusted annual rate of 0.8 percent, health construction increased 0.2 percent (See Table I below the fold).

The difference was especially apparent in private construction. Construction of private health facilities increased 0.5 percent, 0.8 percentage points more than other private construction, which declined.  Construction of public health facilities dropped 1.0 percent, but this was less than half the drop in other public construction.

For the twelve months from May 2015, there is a significant difference in trend between private and public construction. Private construction increased 4.7 percent, and private health facilities starts increased at almost exactly the same rate. However, while public construction declined 2.6 percent, public construction of health facilities dropped only 1.4 percent.

Overall, health construction increased 3.3 percent, versus only 2.8 percent for non-health construction. Notwithstanding other factors, this indicates health costs will continue to increase faster than other sectors of the economy because (as the old saying goes) “a bed built is a bed filled.”

Is this the Insurance Casualty Model; Or Just a Dirty Trick?

The health insurance “Casualty Model” is alive and well in Georgia — but only as a punishment for not signing an in-network agreement or accepting usual and customary reimbursement for emergency room treatments.  At issue is a Georgia hospital (and one in Los Angeles) that are not part of the Blue Cross and Blue Shield of Georgia network. Because neither of the hospitals are part of the insurer’s network, when covered individuals go to the hospitals’ emergency rooms, the insurer sends reimbursement checks for emergency care directly to enrollees. The enrollees are then supposed to endorse the checks over to the hospital.  This is similar to the casualty model when an insurer provides funds for a covered claim and the covered individual shops around and receives a service at the provider of their choice. When someone slid into my car during an ice storm a few years ago, an adjuster came to my office and calculated an estimate. I received the check and was told I could get my car repaired almost anywhere for the estimated amount.

Health Construction Boomlet Collapses in April

Census2The boomlet in health construction from February and March lost its wind in April. While construction overall dropped at a seasonally adjusted annual rate of 1.8 percent, health construction dropped by 3.0 percent (See Table I below the fold).

The drop was much greater for private than public health facilities, especially relative to other construction. Construction of private health facilities dropped 3.6 percent, 2.2 percentage points more than the decline in other private construction.  Construction of public health facilities dropped 0.8 percent, 2.1 percentage points less than the decline in other public facilities.

This turnaround after a two-month boomlet puts health construction back on the longer term trend. For the twelve months from April 2015, construction of non-health facilities boomed 4.7 percent versus a decline of 0.6 percent for health facilities. Notwithstanding other factors, this is welcome because it indicates a shift from inpatient to outpatient care at lower cost.

Health Construction Boomlet Continues

Census2The boomlet in health construction, first noted in last month’s Census Bureau release, continued in March. Health facilities construction starts grew 1.6 percent, while other construction grew only 0.3 percent (Table I).

The rate of growth was significantly greater for public health facilities (2.3 percent) than private health facilities (1.4 percent). Further, the relative growth was much larger for public health facilities, because non-health public construction declined by 2 percent, while non-health private construction grew 0.7 percent.

This is the second month of uptick in health facilities construction. Over the last twelve months, health facilities construction starts have grown only half as fast as non-health starts (4.1 percent versus 8.2 percent). It is too early to say whether the boomlet in health facilities construction indicates a trending upturn. However, it suggests health systems are beginning to be optimistic about their abilities to continue to extract revenue from the system.