Future Sizing

[Incognito]

Yesterday our region got a newsletter blast from one of the upper administrators.  It talked about "Future Sizing" the organization and then proceeded to discuss the loss of revenue due to high deductible insurance and less patients seeking care, increased medicare  and medicaid patients and falling reimbursements, cost of doing business is high.....

 

Therefore the "Future Sizing" project of the system will be instituted by starting to "let go" employees starting October 19th and ending October 29th.  500 in the statewide regions are rumored to be pink-slipped and 100 in my particular region.

 

I'm just waiting for some knucklehead to get the idea that PAs can room their own patients, etc. and my MA will be gone by the end of the week.........just saying.......

 

I just hate politically correct speech....Future Sizing my A#$#$!

 

I imagine some CEO is not going to get their bonus if the loss of revenue is not stopped.

 

They asked for ideas on how to help the future sizing.  

 

I posted "Cut at the top"?

 

I will probably be a target but I have my answer if anything comes back to bite me.

 

Thus, posting as Incognito today. 

 

 

[TWR]

politics is in everything.  Bad news when it effects people's health and the providers that supply the needed medical treatment.

[Reality Check 2]

I just had a former student flat out quit his corporate medicine specialty job because he hasn't had an MA in nearly a year but they kept harping on his numbers......So, rooming pts, answering calls, refilling meds and cleaning rooms should have no effect on PA productivity..... that math doesn't work.

 

Future Sizing - nice term. Nags me like the term "reach out to me". What a bogus term for "not enough executive money"

 

I left corporate medicine and am happy. Benefits aren't as good but I'll cope.

 

Too many chiefs, not enough Indians or however that has been politically corrected.

 

If people aren't coming to the clinics then you aren't offering the services they want or need or your providers stink or you charge too much. Cutting staff won't solve anything - actually finding the root of the problem is the ever illusive 9000 lb elephant no exec wants to deal with.

 

I feel for you. Got those feelers out for options? Get going! Best of luck

[jmj11]

There is a real crisis brewing in American health care.  Reimbursements are falling. Insurance companies, in the wake of the ACA are making more and more complex to get paid. Something has to give. The CEOs of the health insurance companies have seen skyrocketing profits since the ACA.  We have to somehow fight back.  The health insurance companies are at the helm. Their vision of health care is 7-minute appointments, only the cheapest treatments not the most humane or in the best long-term interest of the patient. While hospital executives may earn well, the real change is at the reimbursement level.  The CEOs of health insurance companies have seen their compensation rise in the past 5 years from 4 million per year to 40 million per year for most.  Personally I am ready for a one payor system but without the micromanaging we have seen with the ACA.

[rev ronin]

I wasn't expected to room my own patients or clean rooms, but yes, not having my own dedicated MA was a significant part of why I quit my corporate medicine job.

[TWR]

I am not sure how they do it but in Costa Rica as an American moving there someday, health care costs about $80.00 a month and covers everything including dental.  They have first class healthcare and many physicians from the USA rotate through C.R.  The only down side would be you won't make $500,000 or more annually.  Anyone ever been there? 

PS there literacy rate is 12% higher than USA!

[TWR]

rev ronin,  When I owned my own practice in NYC, I called them in the back, did my own vitals and did my assessment.  If it snowed, I shoveled.  My MAs were with me for 18 years til I moved to Texas.  We all did what had to be done  No one except me had to see patients.  I don't believe in "not my job description"

[rev ronin]

rev ronin,  When I owned my own practice in NYC, I called them in the back, did my own vitals and did my assessment.  If it snowed, I shoveled.  My MAs were with me for 18 years til I moved to Texas.  We all did what had to be done  No one except me had to see patients.  I don't believe in "not my job description"

I do, but not out of any sense of laziness or entitlement.

 

A large organization that has plenty of employees in each categorization is a far different critter than a single-provider practice.  When a large organization makes a decision to cut workers, but not correspondingly reduce the work, that essentially is more work for everyone else. When providers are the only ones not getting overtime if needed, providers end up picking up the slack.  So if you, as a provider, have your productivity expectations raised 15% without any other changes--no new support staff, no decrease in administrative burden, no increase in pay--then you've essentially been handed a 15% pay cut.

 

If someone wants to pay me, as a provider, to do MA level work, that's a clear disconnect--not that anything is "beneath me" as a provider, but that the organization is truly workforce misaligned.  In my current position, I get paid overtime.  I'd be happy to clean toilets, make reminder calls, etc. for that much money... but my boss would be making a fiscally poor decision to have me do that sort of stuff when an MA who makes 1/4 of my salary could do it.

[delco714]

I like the idea of cut from the top. Enoughs enough with all the vice president of senior vice nursing chief care administrator manager lead coordinator..and similar.

[Incognito]

I'll let you know how it all works out.  So far, my MA is still with me.  In fact, the organization is trying to make clinicians more productive so a few months ago they started a project to hire MORE MAs and RNs so we can all do shared visits.  A clinician will have 2 support staff, one to room,  document meds vitals, order tests needed, start immunizations and the other to scribe, educate, close the visit and follow up on any needs the patient has.  The pilot starts as soon as the staff is hires and 3 physicians in my group are in the pilot.  

 

 

So, the organization future sizes at the same time they are up sizing.  Doesn't make sense and I think they have no real strategic plan.

 

Tomorrow I have the privilege on attending a 75 minute touchy feely session on "mapping".  Not sure what that is but I know for sure it is not an airplane ticket to Costa Rica, which sounds like a great place to retire. 

[Guest Paula]

^^^^^  Have fun,  I love that  stuff.....(said tongue in cheek). 

[Torshi]

There is a real crisis brewing in American health care.  Reimbursements are falling. Insurance companies, in the wake of the ACA are making more and more complex to get paid. Something has to give. The CEOs of the health insurance companies have seen skyrocketing profits since the ACA.  We have to somehow fight back.  The health insurance companies are at the helm. Their vision of health care is 7-minute appointments, only the cheapest treatments not the most humane or in the best long-term interest of the patient. While hospital executives may earn well, the real change is at the reimbursement level.  The CEOs of health insurance companies have seen their compensation rise in the past 5 years from 4 million per year to 40 million per year for most.  Personally I am ready for a one payor system but without the micromanaging we have seen with the ACA.

 

A company survives with profits (scary word), how do you think a company will survive w/ the implications of the ACA. The healthcare market is already heavily regulated and has been, price controls, bureaucracy waste, etc all leading to high costs. 

The focus on executives and demonizing them does absolutely nothing. 

[Torshi]

I am not sure how they do it but in Costa Rica as an American moving there someday, health care costs about $80.00 a month and covers everything including dental.  They have first class healthcare and many physicians from the USA rotate through C.R.  The only down side would be you won't make $500,000 or more annually.  Anyone ever been there? 

PS there literacy rate is 12% higher than USA!

and Cuba has a better IMR than the U.S. while neglecting the fact they abort fetuses suspected of high risk during screening and not reporting it. If you don't know how they do it, it's safe to say it may not be statistically true.  

Costa Rica 1st class healthcare? Based on what standards; IMR, life expectancy, preventative, acute, long-term? Again, just like all these South-American countries with "great" healthcare, in fact for "free" whatever that means, while pepto-bismol and toilet paper is literally on the black market. 

[rev ronin]

I've observed Costa Rica healthcare firsthand.  It's not what I would call world class, but it sure beat Guatemalan health care.

[GetMeOuttaThisMess]

I am not sure how they do it but in Costa Rica as an American moving there someday, health care costs about $80.00 a month and covers everything including dental.  They have first class healthcare and many physicians from the USA rotate through C.R.  The only down side would be you won't make $500,000 or more annually.  Anyone ever been there? 

PS there literacy rate is 12% higher than USA!

I plan on stopping by and saying "hello" maybe as early as next summer.  I wouldn't mind being a retired ex-pat at some point if things keep going the way that they are here, and I'm not referencing just our position in the healthcare system. I would like to stay put in my local gov't position through age 62 if they can keep from screwing it up (seems to be a common problem for corporate/gov't employee clinics from my perspective).  Could always go to S. Pacific and get healthcare through Thailand at much cheaper rate and better efficiency as I believe it was as reported on by M. Spurlock last year.

[Reality Check 2]

OP, PLEASE be careful with these shared visit ideas. The non-profit I worked for was piloting these and they pushed my comfort zone on what an RN can legally do in a visit AND charge in the provider's name. It made the hair on my neck stand up when they approached us with it. They thought some stuff wouldn't even have to see the provider which reeks of fraud to me.

 

More MAs and an actual RN (a rare find) can actually make things go slower if you don't have everything precisely lined out on who can do what and when and under what authorization and standing orders vs verbal vs written vs ordered in EMR.

 

Call it naïve but in all my years I have never liked hearing profit and medicine in the same sentence. Thus, I support a single payer system - pay me a decent wage for what I do and let me do right by the patient and I can be happy with that. I don't like RVUs and REVs and all that. It is a negative motivator in medicine - spend less, don't order tests and cut corners - you will be rewarded.

 

Again, as long as insurance execs make 6 figures and 6-7 digit bonuses - our medical system is all messed up.

 

My very old 2 cents....

[jmj11]

A company survives with profits (scary word), how do you think a company will survive w/ the implications of the ACA. The healthcare market is already heavily regulated and has been, price controls, bureaucracy waste, etc all leading to high costs. 

The focus on executives and demonizing them does absolutely nothing. 

It what other part of the business world are your rewarded for mistakes?  Where else can you spend an hour getting a prior authorization and receive it and do the procedure and then the payor says, "We  now decided not to pay that now."  Where else would customers take services for three months and then pay you nothing because their internal policy states that they can not make payments to someone who has a PO Box (not stated in the contract). Then you get a street box (after fighting with the post-office) and the only way to notify the insurance company of your change of address is to send it to THEIR PO BOX.  Where else do you have to spend tens of thousands of dollars fighting denials of payments only . . . in the end . . . discover that it was their mistake but they will not reimburse you for you time and often will not pay you for original charge because now, due to the lapse of time.

 

It is not a level playing ground where the supply / demand of normal business plays out. It is a monopoly control.

 

My point that no other segment of the business world works like health care.  This would be an outrage in the retail world. This is why virtually all small practices are failing because they don't have the deep pockets to play this game or to hire attorneys.  

 

The point is, the insurance companies are welcome to make profits. That is not their sin. Their sin is that they are rapidly alliterating the healthcare landscape in their favor where the real goal should be in the favor of the patient getting better.  All health care must adapt to them (the insurance companies) who's goal is short rapid appointments, the cheapest treatment (most of the time no treatment) for the short-term profit, not for the best outcome of the patient.

 

If there were a thousand insurance companies, like convenient stores, patients could choose the best one. But the way it works, there are a handful of choices and all of them are bad.

 

Yes, we do need some more regulation.  First, insurance companies should not require paperwork and time that they don't pay for. If a practice spends 30 minutes with the patient and they pay $80 for that 30 minutes is one thing (which wound not even cover overhead). But when they then require 2 additional hours of people being on the phone fighting to get paid that $80, then that time must be compensated for or it doesn't work.  No practice can survive being paid $80 for 2 1/2 hours of time.

[BruceBanner]

"Future sizing" = p!ssing on your head and calling it rain.