"... except that this is a major profit center for hospitals, and they use the money to cover other, money losing, departments ..."
I think you, like many people, misunderstand the reimbursement regime as it works in American hospitals currently. A patient in an ICU will typically have a DRG associated with him/her. This DRG relates to the acuity, and these in turn, impact the reimbursement level. This is because the complexity of care, as indicated by the acuity level, implies higher resource utilization. For instance, the patient-nurse ratio in a typical hospital room is somewhere right around 4:1. In ICUs this ratio is, more often, 1:1. The ICU also needs an array of techs for a patient... highly specialized techs capable of analyzing and acting on information coming off of the monitor that the tech is responsible for.
So hospitals are not saying, "Hey... we have these people here who we can get a lot of money out of!" The system, as it currently stands, is "volume based", so money comes in for ICU care regardless of what the hospital wants. One of the issues with being volume based in this fashion, is that money does NOT come in for things like data analytics, nutrition departments and occupational therapy for instance. Now here's the rub... how do you offer comprehensive ICU care without due consideration of nutrition? Without the ability and expertise to analyze the data coming off of what could very well be an extensive array of monitoring equipment?
It actually goes further than that... Most hospitals MUST have a clinical equipment department for which they are not reimbursed at all. Of course, the creation of an ICU withOUT a clinical equipment department is out of the question.
So while there do exist cross subsidies in any given hospital, it misses the mark to view the departments on the receiving end of the subsidies as "money losing". This sort of thinking has led the industry to all of the issues we see presently. A good example is the poor reimbursement of primary care... and so primary care becomes "money losing" when viewed in that manner. Instead, I think these departments would better be viewed in the fashion that they are viewed in the "value based" reimbursement regime that the industry is currently transitioning to.
Not only will care delivery facilities be in a better position to provide care to families like your own and others, but the quality of care will increase across that enterprise. Your family was given high quality care because the hospital took money from a "volume based" reimbursement system, and distributed those monies based on the judgement of what were probably some very clever "value based" administrators. I can pretty much guarantee you that they did not view Clinical Equipment, Data Analytics or Nutrition as "money losing" departments.
One of the things that has been missing in the discussion about the health care system is the education of the typical citizen about the tradeoffs and compromises that, for example, hospitals are making internally to deliver the quality of care that they do. I think if the citizenry had a more full understanding of the nuances of things like the reimbursement system, we could have a more productive debate on the issue of healthcare.
I didn't mean it as a judgement. It's just the reality that some procedures and areas of the hospital reimburse at much higher rates than others, and it's often unrelated to actual expenses. This isn't random speculation on my part -- I've spoken to hospital administrators as well as entrepreneurs working on fixing it.
I think you, like many people, misunderstand the reimbursement regime as it works in American hospitals currently. A patient in an ICU will typically have a DRG associated with him/her. This DRG relates to the acuity, and these in turn, impact the reimbursement level. This is because the complexity of care, as indicated by the acuity level, implies higher resource utilization. For instance, the patient-nurse ratio in a typical hospital room is somewhere right around 4:1. In ICUs this ratio is, more often, 1:1. The ICU also needs an array of techs for a patient... highly specialized techs capable of analyzing and acting on information coming off of the monitor that the tech is responsible for.
So hospitals are not saying, "Hey... we have these people here who we can get a lot of money out of!" The system, as it currently stands, is "volume based", so money comes in for ICU care regardless of what the hospital wants. One of the issues with being volume based in this fashion, is that money does NOT come in for things like data analytics, nutrition departments and occupational therapy for instance. Now here's the rub... how do you offer comprehensive ICU care without due consideration of nutrition? Without the ability and expertise to analyze the data coming off of what could very well be an extensive array of monitoring equipment?
It actually goes further than that... Most hospitals MUST have a clinical equipment department for which they are not reimbursed at all. Of course, the creation of an ICU withOUT a clinical equipment department is out of the question.
So while there do exist cross subsidies in any given hospital, it misses the mark to view the departments on the receiving end of the subsidies as "money losing". This sort of thinking has led the industry to all of the issues we see presently. A good example is the poor reimbursement of primary care... and so primary care becomes "money losing" when viewed in that manner. Instead, I think these departments would better be viewed in the fashion that they are viewed in the "value based" reimbursement regime that the industry is currently transitioning to.
Not only will care delivery facilities be in a better position to provide care to families like your own and others, but the quality of care will increase across that enterprise. Your family was given high quality care because the hospital took money from a "volume based" reimbursement system, and distributed those monies based on the judgement of what were probably some very clever "value based" administrators. I can pretty much guarantee you that they did not view Clinical Equipment, Data Analytics or Nutrition as "money losing" departments.
One of the things that has been missing in the discussion about the health care system is the education of the typical citizen about the tradeoffs and compromises that, for example, hospitals are making internally to deliver the quality of care that they do. I think if the citizenry had a more full understanding of the nuances of things like the reimbursement system, we could have a more productive debate on the issue of healthcare.