Beyond Labels

Now that Robert Mueller’s work is complete(?) and his report issued, we’ll discuss the report’s contents and implications:

• What does the report actually say vs. what the pundits predicted that it would (or say it does)?
• What (specifically) should be done to protect our elections from Russian (or other external) influence?
• And, seemingly of far more interest to the talking heads, what are the implications for the Trump presidency?
  • Has Mueller provided convincing evidence that the President has committed one or more crimes?
  • Is impeachment necessary, appropriate or just a political stunt?
  • Put another way, if you were a US Senator, would you vote to convict based solely on the evidence in the Mueller report? Would you apply a different standard than for a criminal jury trial (other than the unanimity requirement for the latter)?

If you aren’t super-facile with Google (or your favorite alternative search engine), here’s a link to the full Mueller Report (be aware, it’s a pretty big file (~140MB) because of the way it was produced—but this is the new, searchable version direct from the US Department of Justice).

During our “Hancock County Healthcare” discussion today, John Ronan mentioned the incredibly anemic margins for Maine Hospitals—with over half of the hospitals in our state losing money (after fundraising, donations, etc.).

Here is a link to a Maine Hospital Association document that shows the margin trends from 2011 to 2016 (on page 17 of the pdf document). There’s some other good stuff (at least I think so) elsewhere in that document.

Despite the fact that our conversations often touch on healthcare (even if they start with foreign affairs!), this coming Monday’s discussion will be focused specifically on healthcare in Maine and Hancock County.

I thought this would be a suitable topic after reviewing Northern Light Health’s 2018 “Community Benefit Report” (required under IRS regulations) and observing that the system provided more than $220 million of benefits to the communities it serves. That compares to less than $9 million of system “net income” in that year. The good news is that margins were positive; the bad news is that margins are thin. (This isn’t a Northern Light Health-specific issue—many of the hospitals in Maine are losing money and similarly-situated rural hospitals across the country are facing the same margin pressures.)

If you review the report, you will note that a very substantial portion—more than 50% for both the system and Blue Hill—of the “Community Benefit” is the discount to cost (not price) paid by Medicaid and Medicare for services provided to their beneficiaries.

So I hope we can use this perspective as a springboard to discuss hospital finances—to play “CEO (or President)-for-a-day:”

• How can hospitals make up for the un- or under-paid costs of services provided to patients?
• Is there “fat” in the system in amounts large enough to offset these costs?
• How should increasing market costs (provider compensation, medical devices, prescription drugs, non-provider salaries & benefits) be managed?
  • Wage caps?
  • Curtailed services (type, availability, hours)?
  • Reduced investment in facilities and equipment?
  • Higher prices for those who don’t have the Federal government’s ability to dictate what it will pay?
• How can a commitment to quality be maintained in this environment?

I have invited John Ronan, President of Maine Coast Hospital and Blue Hill Hospital and the Chairman-elect of the Maine Hospital Association, to join us on Monday. In addition to providing an insider’s view on local hospital finances, he can speak to some of the issues facing our local facilities and provide context on the rest of Maine as well.

Homework

If you’re eager to do some homework, here are some resources that you might want to review:

Medicare for All

• Bernie Sanders says Medicare-for-all would reduce health spending. But that’s unclear. (Washington Post, April 17)

System/Hospital IRS Form 990s

(These show financial results, community benefit, compensation)

• 2016 Northern Light Health
• 2016 Blue Hill Hospital
• 2016 Maine Coast Hospital

Electronic Medical Records

And this one, courtesy of Retta Clews:

• Death by a Thousand Clicks (Kaiser Health News)