Health Care Thoughts: Hospital Job Cuts and Job Gains
by Tom aka Rusty Rustbelt
Health Care Thoughts: Hospital Job Cuts and Job Gains
I have been spending a great deal of time lately communicating with health care experts far above my modest standing, mostly on publishing projects and seminar scheduling for next year.
One hot topic among the wired in folks is hospital layoffs, not usually large per hospital but a steady drip drip since 2009.
The buzz I am getting is the next two or three years will see a net job loss of about 400,000 as Medicare and Medicaid cuts, combined with incentives to reduce stays and re-admissions, chip away at hospital budgets. Most of the cuts will be from clinical and maintenance areas.
Notice the “net,” hospitals will be doing some hiring during the job cuts. The hospitals will be hiring IT geeks, finance and accounting geeks, nurse managers, case managers and executives.
Some of this is fallout from the economy, but much of it will be changes necessitated by PPACA, especially for those organizations moving into accountable care organizations.
More accountants, fewer nurses. Beware of unintended consequences.
(Dan here…I have some comments and questions in comments hopefully tonight)
Note that in a comment my cousin who is an RN and a nurse educator, indicated that RN’s today do more record keeping than real nursing. If part of the goal is to reduce the time RNs spend record keeping devoting it to the nurse manager it may be just a wash.
I also have only anecdotal data like Lyle and Rusty, and do not have access to the admin./cfo/ceo levels of hospitals.
But it seems to me there are cost cutting trends here that were happening well before Obamocare, such as staffing patterns that put a steadily increasing ratio patients for each nurse on the floor.
One ER doc at a famous hospital here mentioned the number of cases demanded from docs went from 270 to 400 per time unit.
There are probably almost no 40 hr. work weeks positions…mostly 24 hr. and 32 hr., and many per diem. Labor flexibility maximized, with mandated time filling in the holes.
From the provider side, insurance company paperwork has been increasing steadily for years, with the complexity of plans and contracts touted as choice proliferating to the point where the time demanded to correct mistakes made by the insurance company computers begins to rival patient time when there is a problem…establishing what a plan covers and how payment is made can be difficult until after the fact.
Can anyone point us to research on patterns. While feedback from admin is useful, the Hospital Assoc. and insurance company group, I see not so much analysis that seem to include money flows.
I suspect as cost cutting happens, were we to even stop medical inflation and keep costs stable (rising faster this year) dislocations, winners and losers, and such have a life of their own aside from Obamacare. And I am not even disagreeing with you Rusty.
Dan:
Change and reorganization has been happening in health care for at least 38 years, since I was a baby accountant.
My concern here is we may have reached or will reach a tipping point, inadvertently, at which the change is too fast to be controlled, or perhaps focused on the wrong changes.
For example, at this moment hospitals are focused on preventing Medicare re-admissions, and I fear the cost accountants and data crunchers may have too much sway.
The unintended consequences of PPACA could be profound, as sweeping changes take hold.
Not to be a pessimist, but I have a long list of issues to worry about. Somehow I think, we will work through them.
As long as we keep a for profit health care system; there can not be any real improvement in care, as profit is the only real goal. PPACA only real benefit to the sick is the insurers can no longer dump them on to medicaid.
Hey Dan,
I published this: http://www.angrybearblog.com/2009/07/massachusetts-is-fixing-fixed-health.html
2009 which has charts regarding the rise in administration personel compared to Canada.
“Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-industry personnel.)”
Anon:
The big not-for-profit systems are just as mercenary as the for profits.
If you are suggesting a government system, keep in mind a government system would have to (like the military) purchase directly or indirectly through the private sector.
Dan:
The EMR/EHR push is going to push up administrative costs, at least in the near term.
The conversion to ICD-10 will be another welfare act for geeks.
rusty
there is no need for “government system” to be either like the defense department or some kafka hell.
in the state highway department, we decide where we want a road or bridge and write the specifications and the private contractors bid for the job. then we oversee their work to make sure we don’t get cheated. we also learn how to make it better next time. at least in my state is was honest and efficient.
no reason why the government couldn’t do medical insurance the same way. write the specs, put it out to bid, oversee the work. there needs to be oversight or “your money or your life” will inevitably price poor people out of the market. leaving it up to the states would probably result in the states being captured by the insurance companies. could of course also happen to the federal government, but that would tend to be easier to see and resist.
Rusty,
I agree, but that (EHR/EMR) is not all my article and the referrences were talking about.
The current private system has, just as the banking system found an additional means to extract money. They are making money off of “management” and it is not because of the savings.
They are making money off of “management” and it is not because of the savings.
Not sure what that means. Providers are not making money off of higher administrative costs pushed on them by regulations.