Hospitals look to become insurers

[antigop]

http://www.kaiserhealthnews.org/Stories/2012/August/26/hospital-insurers.aspx

Michael Dowling, a burly Ireland native running one of New York’s largest hospital networks, is preparing to turn his business model on its head: He wants to keep his hospital beds empty, rather than full.

That’s because the North Shore-LIJ Health System, with 16 hospitals and more than 300 outpatient centers in Long Island and New York City, is laying the groundwork to be an insurer, as well as a provider of health care.

Like other hospital chains across the country, it’s under intense pressure from public and private insurers, as well as employers, to accept flat-rate payments for care, rather than reimbursements for every service. And that puts pressure on hospitals not just to manage costs, but to keep people well – in short, to act more like insurers.

“This is a huge, dramatic cultural shift,” said Dowling, president and CEO of North Shore-LIJ, who expects it will take several years to market coverage to the general public.

Once the system becomes an insurer, picking up the tab for a hospitalization rather than generating revenue from it, more resources will be devoted to preventive care, Dowling said.

[Hoyt]

1. The Affordable Care Act includes incentives for them to do just that.

Conceptually, it's a good thing.

How it will actually work in practice, tough to say. It's actually little more than a hospital controlled HMO (other health care providers could do the same, but right now hospitals have the money to do it).

[mrmpa]

2. UPMC in Pittsburgh does it ............

that's the University of Pittsburgh Medical Center. They own all but about 4 hospitals in the area. They are currently in a hostile environment with Highmark Blue Cross Shield, because Highmark just bought 2 hospitals. What it is as Hoyt say it's a hospital controlled HMO.

I personally dislike UPMC hospitals. I had knee replacement at a UPMC, the care was terrible, I could describe it in paragraphs, but I won't. Suffice it to say I will stay away from their hospitals as much as I can.

On Friday about 3 p.m. during my stay, I heard laughter in the Halls and Nurses talking to each other (something I hadn't heard earlier in the week). This told me that the UPMC administrators were now gone for the weekend, and tension had eased up.

SEIU is in a fight to organize at UPMC hospitals, and UPMC is fighting them with no restraint.