Update: The ER rooms are ok as they are not affected...according to the article here the insurance companies refused to negotiate rates with Prime HealthCare ....one surgeon commented the hospital is becoming a giant ER room...as one statement was issued, "Prime selectively chooses hospitals they think they can turn around"....meanwhile physicians move and layoffs continue..BD
Centinela serves one of the poorest regions of Los Angeles County, it doesn't have the fundraising power of other hospitals to remain solvent, Crockett said.
Instead, Reddy and other officials put the onus on insurance companies. After the sale was announced in November, hospital officials sent notices to Blue Cross, Blue Shield, Aetna, PacifiCare and Health Net that they wanted to renegotiate rates. The companies refused, hospital officials said, and as a result, HMO contracts were canceled as of Dec. 31. Centinela still accepts patients covered by PPO plans, and takes Medicare and Medi-Cal.
Ultimately, patients get put in the middle - and in many cases, end up paying higher costs, said Nicole Evans, spokeswoman for the California Association of Health Care Plans, a trade association that represents 40 HMO insurance carriers.
What often happens, she said, is the insurance company pays the contractual rate for emergency care - even if they don't have a contract in place - and the hospital sends the patient a bill for the difference. The patient should call the insurance company to dispute the cost, she said, but many wind up just paying it.
The Daily Breeze - Patients caught in Centinela Hospital Medical Center's shake-up
Don't forget about the squeeze on doctors and nurses. Well respected specialists are being forced out as this tertiary medical center is transformed into a mere urgent health center that concentrates in making money through ER patients. Excellent physicians in orthopedic surgery and interventional cardiology are leaving. Rehab and Radiation Oncology Centers have been cut. Operating Room time have been severely restricted, and many supporting staff have been cut. In concert, patient care is being manipulated to maximize Medicare and insurance reimbursements. Necessary therapies are not done if expensive, and optional measures are being done if profitable. All the while, uninsured patients are kept longer in the ER for a "work-up", while insured patients are rapidly admitted before the midnight cutoff to maximize profit. Reddy is a smart business man who uses his M.D. as a front. Shrewd move, but highly unethical. However, prior administration and owner were no saints either. There were many unethical practices that made money for the investors, while the hospital suffered $2 million loss monthly. Money was not spent on improving the facility, but fattened the investor's wallets. From an insider's perspective, Reddy's program of change need to be evaluated in detail by the government (state and city) to make sure the level of medical care is adequate the serve the needs of the community.
ReplyDeleteI know we see good hospitals closing all around the country and it is sad as it it eventually lead to a shortage and is basically survival of the fittest out there, not necessarily survival of the best run facilities, but those with some money. I think the move to stop Dr. Reddy from purchasing Anaheim Memorial showed a bit of concern too as far as how far can this all go before it flops over 100% and we have very few hospitals to go to, those of us without huge bank rolls that is.
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