It's no coincidence that the word "hospitality" sounds a lot like "hospital." It dates back to the Middle Ages, with a religious order known as the Knights Hospitaller, who considered it their sacred duty to build houses of hospitality (abbreviated as "hospitals") to care for the poor and needy. Over time, this mission gradually morphed into caring for the sick, because people realized that a hospital would take in sick people when no one else would, as the knights' religious vows were stronger than their fear of contagion.
As time passes and technology progresses, particularly over the past 2 centuries, no one would expect a modern-day hospital to physically resemble a House of Hospitality. But the way they have changed *structurally,* the way their organization and operational practices no longer even vaguely resemble the Hospitallers' system, is quite frankly an abomination. Modern-day "hospitals" are not worthy of the sacred name they have appropriated.
Great comment letter! You touched on a topic that I think merits more attention. Hospitals only have to treat patients in an emergency. Cancer is not an emergency. Congress should study hospital admission standards more closely. Many hospital systems - including state funded university facilities - refuse to accept ACA exchange plans, no network plans, or Medicare Advantage plans for various business reasons (primarily lower reimbursement). And cash pay or no network plans only work if the patient is wealthy enough to have a substantial cash deposit. It’s the same situation with physician groups. My sister could not get an appointment with a major oncology physician group because she was uninsured. The group administrator told me they did not want to accept cash pay because oncology drugs are so expensive that most patients eventually run out of funds due to cost. This will be the challenge for non network plans. It’s a risky proposition to buy one if you have a family history of cancer.
Maybe I am the only one, but I need a lesson on how these Federal programs assigning percentage payments (for drugs only?) are supposed to work and what loose rules are allowing hospitals to refuse to accept coverage. I also want to know how to keep small NH hospitals open for the folks living upcountry where population is sparse.
I love how you talk. I'd like to think I talk like that, however mine is not so pithy, but pithy enough to leave some friends telling me I've left them in the dust!
Such good questions Betty!! Yes, Medicare has law that determines its rate (average sales price plus a margin or a different price that is closer to the real price based on asking the hospitals themselves). But the 340B program requires that participating hospitals can charge whatever they want for a drug by non-Medicare plans but they BUY the drug at a tiny fraction of what the average sales price is. So Medicare is saying - “we’re doing the survey. You guys told us what you’re buying the drug for and it’s a LOT (33%) lower than the average sales price so we’re not going to pay you average sales price plus a margin anymore.”
I’ve argued elsewhere that hospitals should not be profitable. Their highest value services can’t be made profitable and all the games played are to subsidize those losses with irrational and unethical gains elsewhere. This is true of MOST charities so there’s nothing special about hospitals. They should be making the case to donors and their local communities to give them money. They should be seeking grants and help honestly from governments and other donors. Like every other charity. If they’re behaving badly and they’ve lost the trust of their communities and can’t raise funds then they should reflect on that fact a bit more.
I like the slightly slower tempo in which you read this one. 👌🏼
Brilliant letter! Hope it gets traction.
I try!! But it’s hard for a fast talker. Maybe listen at .75 speed!?
Very good idea. But your tempo for you last two articles has been perfect.
Was thinking of you!!
Ha ha, thanks, @Katy Talento ND ScM
It's no coincidence that the word "hospitality" sounds a lot like "hospital." It dates back to the Middle Ages, with a religious order known as the Knights Hospitaller, who considered it their sacred duty to build houses of hospitality (abbreviated as "hospitals") to care for the poor and needy. Over time, this mission gradually morphed into caring for the sick, because people realized that a hospital would take in sick people when no one else would, as the knights' religious vows were stronger than their fear of contagion.
As time passes and technology progresses, particularly over the past 2 centuries, no one would expect a modern-day hospital to physically resemble a House of Hospitality. But the way they have changed *structurally,* the way their organization and operational practices no longer even vaguely resemble the Hospitallers' system, is quite frankly an abomination. Modern-day "hospitals" are not worthy of the sacred name they have appropriated.
💯
Great comment letter! You touched on a topic that I think merits more attention. Hospitals only have to treat patients in an emergency. Cancer is not an emergency. Congress should study hospital admission standards more closely. Many hospital systems - including state funded university facilities - refuse to accept ACA exchange plans, no network plans, or Medicare Advantage plans for various business reasons (primarily lower reimbursement). And cash pay or no network plans only work if the patient is wealthy enough to have a substantial cash deposit. It’s the same situation with physician groups. My sister could not get an appointment with a major oncology physician group because she was uninsured. The group administrator told me they did not want to accept cash pay because oncology drugs are so expensive that most patients eventually run out of funds due to cost. This will be the challenge for non network plans. It’s a risky proposition to buy one if you have a family history of cancer.
100% Pati!! It’s totally outrageous.
Maybe I am the only one, but I need a lesson on how these Federal programs assigning percentage payments (for drugs only?) are supposed to work and what loose rules are allowing hospitals to refuse to accept coverage. I also want to know how to keep small NH hospitals open for the folks living upcountry where population is sparse.
I love how you talk. I'd like to think I talk like that, however mine is not so pithy, but pithy enough to leave some friends telling me I've left them in the dust!
Such good questions Betty!! Yes, Medicare has law that determines its rate (average sales price plus a margin or a different price that is closer to the real price based on asking the hospitals themselves). But the 340B program requires that participating hospitals can charge whatever they want for a drug by non-Medicare plans but they BUY the drug at a tiny fraction of what the average sales price is. So Medicare is saying - “we’re doing the survey. You guys told us what you’re buying the drug for and it’s a LOT (33%) lower than the average sales price so we’re not going to pay you average sales price plus a margin anymore.”
I’ve argued elsewhere that hospitals should not be profitable. Their highest value services can’t be made profitable and all the games played are to subsidize those losses with irrational and unethical gains elsewhere. This is true of MOST charities so there’s nothing special about hospitals. They should be making the case to donors and their local communities to give them money. They should be seeking grants and help honestly from governments and other donors. Like every other charity. If they’re behaving badly and they’ve lost the trust of their communities and can’t raise funds then they should reflect on that fact a bit more.