Monday, October 29, 2018

A Truism

It is a truism in business that you get the results you are managing for.

This does not mean you get the results you want. It does not mean you get the results you expected. It definitely doesn't mean you are getting the results you thought you managing for.

Case in Point: Rural Hospitals Keep Closing

The article is in the New York Times so they seem bewildered.

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UPDATE: Aesop left a long thoughtful comment that everyone should read. In it he makes my point, The Affordable Care Act was designed to consolidate medical services. Smaller rural hospitals have been closing for years, for all reasons he mentions,  here's what he had to say:

1) There is nothing wrong with the NYT story, per se.
2) They hit all the reasons.
a) One-horse hospitals are being closed by ruinous malpractice premiums. Tort reform is long overdue.
b) Indigent/uninsured care hits small potatoes hospitals a lot harder than conglomerates with multiple hospitals, because they have no way to spread that financial load.
c) Care at small rural hospitals, compared to larger suburban and urban medical centers, is minimally adequate to borderline sub-standard. If anything "serious" needs Lifeflight to the city anyways, you aren't running a hospital, you're running a clinic, whether anyone told you or not.
d) Expanding the Medicaid mandate costs states huge sums of money, which inevitably drives up taxes for everyone. If you kill jobs and tax people out of their homes, you won't just lose the hospitals, you'll lose the residents themselves.

What the NYT didn't tell you was that all of this was factored into ObozoCare, as it was intended to, in order to chain everyone to Big Daddy government, and push more people into cities, and out of more rural (and self-sufficient) living and lifestyles. That was known when they did it, but most of "flyover land" isn't having any, thankyouverymuch.

Good for them.

What you need in rural areas is primary care, not a mini-mart trying (poorly) to do Big City Care.

Trauma is even worse in rural areas because you never had trauma care there, and never will. One major case could break the hospital.
That's what medical evacuation is for.

Critical care (heart attacks & strokes) is essentially the same story: you can't have an ICU in Podunk, because it'll either be empty, or overflowing, and so even if you have it on paper, you don't in reality. So people will need transfer to Big City Hospital anyways. That's just how it goes.

More hospitals close than open because doing one right can no longer be done on a shoestring budget in Hooterville. Or even Pixley. You need the population of a city of a minimum of 100K people to do a small hospital, and 500K or more to do an actual decent primary facility that can offer everything.

By a strange coincidence, you don't have 97 dining choices in Ruraltopia either, or 3 mega-malls, or 5 multiplexes, and a professional sports team or 3.
But you also don't have multi-racial ghettoes, a gang problem, a crime problem, a homeless problem, and a host of other pestilential problems of the Big City.

Most folks who live there see that as a feature, not a bug.

3 comments:

drjim said...

The NYT lost it's grip on reality decades ago....

Aesop said...

1) There is nothing wrong with the NYT story, per se.
2) They hit all the reasons.
a) One-horse hospitals are being closed by ruinous malpractice premiums. Tort reform is long overdue.
b) Indigent/uninsured care hits small potatoes hospitals a lot harder than conglomerates with multiple hospitals, because they have no way to spread that financial load.
c) Care at small rural hospitals, compared to larger suburban and urban medical centers, is minimally adequate to borderline sub-standard. If anything "serious" needs Lifeflight to the city anyways, you aren't running a hospital, you're running a clinic, whether anyone told you or not.
d) Expanding the Medicaid mandate costs states huge sums of money, which inevitably drives up taxes for everyone. If you kill jobs and tax people out of their homes, you won't just lose the hospitals, you'll lose the residents themselves.

What the NYT didn't tell you was that all of this was factored into ObozoCare, as it was intended to, in order to chain everyone to Big Daddy government, and push more people into cities, and out of more rural (and self-sufficient) living and lifestyles. That was known when they did it, but most of "flyover land" isn't having any, thankyouverymuch.

Good for them.

What you need in rural areas is primary care, not a mini-mart trying (poorly) to do Big City Care.

Trauma is even worse in rural areas because you never had trauma care there, and never will. One major case could break the hospital.
That's what medical evacuation is for.

Critical care (heart attacks & strokes) is essentially the same story: you can't have an ICU in Podunk, because it'll either be empty, or overflowing, and so even if you have it on paper, you don't in reality. So people will need transfer to Big City Hospital anyways. That's just how it goes.

More hospitals close than open because doing one right can no longer be done on a shoestring budget in Hooterville. Or even Pixley. You need the population of a city of a minimum of 100K people to do a small hospital, and 500K or more to do an actual decent primary facility that can offer everything.

By a strange coincidence, you don't have 97 dining choices in Ruraltopia either, or 3 mega-malls, or 5 multiplexes, and a professional sports team or 3.
But you also don't have multi-racial ghettoes, a gang problem, a crime problem, a homeless problem, and a host of other pestilential problems of the Big City.

Most folks who live there see that as a feature, not a bug.

grendel said...

With regard to point C), if you live 3hrs from a major medical center, then you need at least some front line care for stroke, trauma, and Cardiac emergencies to be available closer to home. It doesn't matter if you want to call it a clinic.
As a 15 year veteran of rural healthcare, I find your viewpoint myopic. There have been small community hospitals, Obamacare is killing them, and you don't really seem to care or think it's a loss. It's basically the same attitude as a conservative who hears that 4 of 5 national chains have banned concealed carry or MAGA hats or whatever and says "Whatever, I shop at store 5 anyway."