Where have all the patients gone...

March 3, 2014 5:07 PM

I work at my local County Hospital and for the last two weeks we've had a very low census. I hear rumors that the local Giant HMO and local For Profit Hospital Chain are packed right now. I also know one Local For Profit but Independent and Unaffiliated Hospital is at risk of closing right now because of extremely low census. So for folks who actually work in hospitals (and clinics?) are you seeing a change in number of patients since Obamacare started?

Are public hospitals likely to start closing due to changes in health care structure? I am interested in answers both from people with big picture analysis and from people who work in the field so can see the immediate impacts.

posted by latkes to Society & Culture (6 answers total)

I work in a hospital. No change in our census, we've been packed. We are the local equivalent of the county hospital. Why do you think there would be fewer patients in the hospital because of Obamacare? From what I know from the healthcare economics course I took back in the day, studies show that people who have insurance tend to use healthcare services more. If uninsured people get insured, I might not get paid a lot by seeing them, but it's more than the zero I was getting paid to see them before. So my outlook on Obamacare is that it will have a positive effect for my business both because people will use healthcare services more, and also I'll see fewer of the "I had to come here because I have no primary care" visits because people will get primary care doctors. Now, the problem's going to be that once everyone who's newly insured needs a primary care doctor, there won't be enough primary care doctors to go around. But we'll have to find other solutions to that problem. Like paying primary care doctors more reasonably for the very valuable services they provide.
posted by treehorn+bunny at 6:48 PM on March 3, 2014 [3 favorites]

Note: the benefit to me of people having primary care doctors is not financial, it just makes my job easier when people have follow-up after they leave the emergency department.
posted by treehorn+bunny at 6:49 PM on March 3, 2014

Response by poster: Why do you think there would be fewer patients in the hospital because of Obamacare?

Because everyone except undocumented folks can go to a different hospital now. Since many county hospitals, mine included, have a reputation for less than fancy care, more people are signing up for private insurance than for insurance that would send them to my hospital.

It's not that I think there are fewer patients overall now, it's that I wonder if the patients will all go elsewhere.

Note, I'm not "anti-Obamacare", (except in that it's less than the universal coverage I'd like), but I'm wondering if it will have a net impact of gutting the limited public (as in, owned by the people rather than by a private company) health infrastructure.
posted by latkes at 7:01 PM on March 3, 2014

There have been at least two rural hospitals that closed here in Georgia due to the changes in the federal laws/payment schedules, combined with our neanderthal governor's and legislatures actions.
Medicare payment amounts per service to hospitals were reduced, the trade off was that more people would *have* medicare, thus eliminating much of the losses from treating the uninsured.
Of course, using a federal program that pays for that expanded medicare with virtually no cost to the state is.. derp derp Tyranny! derp derp. If you want to be truly patriotic, you'll die in the ambulance on the way to the next nearest hospital a couple counties over, whether you have medicare, insurance, or not.
posted by rudd135 at 7:17 PM on March 3, 2014 [1 favorite]

I work in a private, for profit psychiatric only hospital. Our census is about the same. We have seen patients with the new Private Option insurance policies(as we call them) but I wouldnt say a huge flood of them. I think it depends on how your state handled the issue. For Arkansas, some got Medicaid (which we do not accept so they wouldnt have come to us before ACA) but a lot wound up with policies from regular insurance companies that we are in network with already, so they would be referred to us regardless of whether or not their policy came from ACA or an employer. We have gotten calls for admission appointments from people who said they had to wait forACA before they could get treatment, etc.

Is your hospital in network with the policies people are getting in your area? Also hospital reputation does count so if people know they can get better care at a nearby hospital and its not a dire emergency they will go.
posted by MultiFaceted at 9:53 AM on March 4, 2014

I am a specialist in private practice. We see privately insured, Medicare, Medicaid, and uninsured patients. We have seen a drop in the total number of patients seen since the first of the year and especially in privately insured patients. Maybe this happens every year when folks have large deductibles to meet (this is my first year out of residency). But my senior partners and members of other groups have been complaining about business too. Of course, that's always followed by an Obamacare slam. Hopefully it will pick up soon. Medicine is changing and unfortunately the old guys' pessimism is beginning to rub off on me.
posted by robstercraw at 11:29 AM on March 4, 2014