The Fugitive

Well as the under-utilized naval ship sailed away from the harbor (whosever idea that was showed how tax payer dollars are abused that one was it) to the temporary closing (as in still set up but not being used) Javitz Center and the tents of the Salvation Army or whatever weird fucking religious crew run by homophobe Franklin Graham on public lands, which could have been used well for the public to go while being locked down, get folded up we are back to just the overworked and underprepared/supplied public hospitals, and those private ones stocked by Warren Buffet, to treat the  new/next/more Covid patients. The ones in the prisons or in Convents, nursing homes well you will be fine if no one notices you are dead.  And well even those on the Subway, again wondering how many hours those bodies were there shedding viruses or whatever caused them to die.  Remember if you are not tested POS for Covid and you die you die of that but still are likely counted as dead by Covid, maybe or maybe not. Who knows?  Does anyone care?  Well apparently law enforcement does.

I had read about arrests, chases and hunts of others in other less democratic countries who had escaped Covid treatment facilities; such as the woman in Chile, Russia, India , Africa and even Israel. 

When I read this article in the Tennessean about a homeless man who “escaped” the Covid facility from the fairgrounds (where I lived only about a mile away) and was set up exclusively for homeless it again made me wonder who was being treated at the varying satellite facilities in New York and New Jersey. Something tells me not the insured or the white but what do I know? Well nothing as they don’t tell you shit screaming HIPAA laws. Well wrong again.

Yes folks buried in the article was the policy regarding HIPAA and the ruling on public safety (of which there are many guidelines) .  Good times as this is what I had been looking for when I tried to explain to someone that HIPAA does not apply in the case of COVID as it is highly infectious and back in the day during the height of the AIDS crisis that debate raged as it was believed solely blood born and sexually transmitted.  Then came the Ryan White story and the affect on the blood supply and well game on and hence the law in New York that if you have had sex in the last 6 months you cannot donate blood despite that all blood regardless of donors sexual history is tested for any disease including AIDS.  That is called the work-around. And of course with Covid that is contagious via close contact,  the same way but without sex, meaning that coughing, sneezing, drooling, vomiting, diarrhea,  heavy sweat (as in a fever) makes this virus virulent and highly transmittable.  No it is not again in the air like measles, whooping cough or TB all by coming into contact via the air.  Covid is  flu like and that means close prolonged contact.  So keep moving and when out wash your hands immediately upon returning from those essential errands, then clean the surfaces that anything you brought in touched and dispose of those items, toss the gloves, the mask in the trash or in turn wash your mask after wearing and then finally clean your skin, such as a face or exposed areas again to eliminate any potential infection.  But no the virus is not floating in the air in the same way airborne diseases are unless again in a confined space.. you know the ones I keep mentioning.  But if you live in an apartment or home with others they have to follow the exact same protocol which means intense cleaning and agreement on that policy and good luck with that.  You might want to escape too.

I am all for my civil rights being ignored in a public health crisis and in a state of emergency, again 9/11 anyone. And that little office that housed ex-patriot Edward Snowden, is an example of what they did in the surveillance state. We have the capability and technology, Stingray’s anyone?  All available to monitor and track and trace people. So to have corporations such as Google and Apple come up with an App for that, I say no thanks.  Sorry but no. They are already underfire for either not providing or providing such information to law enforcement to use at their discretion and those cases of SWAT arriving at doors and taking down bad guys has worked out so well or not. What.ever. you decide.  And that is the problem, the lack of consistency, oversight, regulations and other issues that well ended up with stop and frisk, the drug wars and the new Jim Crow and the incarcerations of black men. It ends up with immigrants being detained for no actual crime and of course just innocent people getting caught in the crossfire.  So no thanks on that one.

I don’t take my phone anywhere.  I have a daily journal that I mark where I go and what I did that day and in turn most likely would provide that info if asked but most likely I would also tell the usual suspects whom I do contact regularly what my status is.  I also would do the testing at a private physician to speed up the results and also keep them private as unless I go to a hospital as it is a need to know basis and who needs to know?  I also know that as I am single, a woman and without an advocate I would be shoved onto a ventilator or put in some satellite facility as I don’t have health insurance.  So yes death panels do exist.   It is also why the journal along with all my directives, will and the like sits on my desk.  I have no ICE and there is no need as I am quite clear and there can be no confusion with it clearly marked and dated.  It is also notarized and updated annually.  So I have learned first hand how neglectful and abusive hospitals are.  Ask me about my experience at Harborview Medical Center in Seattle in 2012. They treated me like animal and I will never cheer medical personnel for as long as I live as a result.

Why this is so bad is  because right now no one is tracking, testing or tracing.  A woman here in Jersey City died from a heart attack brought on by an asthma attack; she originally was turned away from a hospital as she did not exhibit ALL of the symptoms(as if anyone does), got worse and by the time she returned to the same facility she was too ill and died.  Her death is listed as the result of a heart attack. Okay then, as she was never tested even in post mortem and yet since that time 9 others in her same building have all tested positive, a sort of mini hot zone if you will.  None of them knew about the other and there you go and the building was not cleaned or even touched to reduce the spread from day one.. at least in my building where we “know” of three units none of the staff knew until after and they are pissed, one quit.  So there you go. So much for public safety. Again the virus from symptoms to actual affects on the body varies and so if you are in at “at risk” group you should be tested immediately if one symptom is present, not because of a checklist, and in turn if you have other health issues immediately put on a 24-48 hour watch (many times it is week two when all hell breaks lose)  and that can be at a satellite facility with close contact upon release to ensure you are receiving appropriate, contactless care and in turn tested upon having no symptoms. That has not happened and again if it has what are the numbers for those cases and the results?

So why would you not escape as you aint’ getting shit. And neither are we.  And I would be happy to allow these facilities or organizations and hotels that are open of these kind of business to be available to treat all kinds of COVID patients and the like if they are just that, equipped, trained and able to do so.  Not so sure about that either as if you are short of PPE, etc then what do they have and are they able to do anything but handle the most minor of cases and if they do code then what?  So if this is about public safety and tax dollars we have the right to know and HIPAA has allowed us that much so cough it up… pun intended.

Tennessee, Nashville health officials provide names of those testing positive for coronavirus to police

Natalie Allison and Yihyun Jeong, Nashville
 Tennessean May 8, 2020

Gov. Bill Lee says the state’s release to police departments and sheriff’s offices the names and addresses of Tennesseans who have tested positive for the coronavirus is necessary to protect officers’ lives — information that is also being independently shared between city health officials and police in Nashville.

Lee told reporters at Second Harvest Food Bank in Nashville on Friday the details are only for those working “from a law enforcement standpoint” to know who has tested positive.

“We believe that that’s appropriate to protect the lives of law enforcement,” Lee said when asked why police need the information

The Tennessee Lookout, a new nonprofit news organization, first reported the agreement between local law enforcement agencies and the state Department of Health, which is releasing the information.

The agencies receiving lists from the state of individuals who have contracted the coronavirus include the Knoxville Police Department, the Nashville Airport Authority, the Montgomery County Sheriff’s Office and dozens more.
Nashville health officials share coronavirus patient data with police, fire officials

Separately, in Nashville, the Metro Health Department confirmed to The Tennessean Friday that officials have been providing to the Metro Nashville Police Department the addresses of people who have tested positive or are quarantined for COVID-19.

The data is inputted into the police department’s computer system so that any officer who has contact with an individual who has tested positive for the virus can take additional precautions, Metro Health spokesperson Brian Todd said.

Metro police spokesman Don Aaron said in a similar statement the department uses the information so officers can “take additional precautions.”

The information is also put into the Department of Emergency Communications dispatch system so that fire and EMS workers responding to an address can take steps to use increased personal protective equipment and distancing protocols.

“At no time is this data shared with the U.S. Immigration and Customs Enforcement (ICE) or the Davidson County Sheriff’s Office,” Todd said in a statement.

In a statement, Cooper spokesperson Chris Song reiterated Todd’s comments, and said the information is “safely kept” among Metro agencies.

“We are taking necessary precautions to protect both our first responders and our residents, including those who are part of Nashville’s diverse immigrant communities,” Song said, adding officials are communicating with community partners that the information will not be shared with federal immigration authorities.

“As Mayor Cooper has stated repeatedly, everyone deserves to feel safe in our community, including our front line personnel and the valued members of our immigrant communities,” he said in a statement.

Though the data isn’t not shared with the sheriff’s office, the health department said if a police officer arrests a person who has tested positive for COVID-19, they will inform sheriff’s personnel when releasing them into their custody.

All public safety personnel have been noticed that the information cannot be publicly released and is for “official use only,” Todd and Aaron said. Unauthorized use is a violation of Metro police policy.

The information is updated regularly, and once a person has recovered from COVID-19, they are removed from the list.

According to the Tennessee Department of Health, as of Friday 68 police chiefs and sheriffs have signed on to a memorandum of understanding that they will receive a running list of names and addresses of individuals in Tennessee “documented as having tested positive, or received treatment for COVID-19.”

The list is updated for law enforcement each day, the MOU states, and individuals’ names are removed from the list after 30 days.

Metro police and the Davidson County Sheriff’s Office have no plans to move into an agreement with the state, according to both Aaron and Todd.

Hedy Weinberg, executive director of the American Civil Liberties Union of Tennessee, criticized the policy’s impact on privacy and said it’s more important for law enforcement “Protecting the health of first responders is certainly an important priority. However, as public health experts have noted, disclosing names and addresses of positive cases does not protect first responders, as many people have not been tested and many people who do carry the virus are asymptomatic,” Weinberg said in a statement.

“Disclosing the personal information of individuals who will never have contact with law enforcement raises fundamental concerns about privacy without yielding a significant public health benefit. It is incumbent that any government policy implemented during the pandemic be grounded in science and public health and be no more intrusive on civil liberties than absolutely necessary.”

The Tennessee Immigration and Refugee Rights Coalition has worked during the pandemic to reduce barriers preventing immigrants statewide from getting care and have formally partnered with Metro Nashville and other organizations to increase more community outreach.

In a statement posted on Twitter Friday, TIRRC said the state’s policy to share information with law enforcement should be “rescinded immediately.”

“This completely undermines all of the work organizations like ours are doing to encourage people to go get tested. This will exacerbate the public health crisis,” TIRRC said.

The group did not immediately respond to a request for comment about Nashville’s policy.

Lee said Friday the state was providing this information to law enforcement agencies in compliance with guidelines put forth by the federal Department of Health and Human Services.

A document published by DHHS’ Office for Civil Rights states the HIPAA Privacy Rule permits an entity like a health department to release protected health information to first responders “to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.”

Shelley Walker, spokesperson fro the Tennessee Department of Health, said in a statement the department “believes these disclosures are necessary to avert a serious threat to health or safety.”

More than 14,000 people in Tennessee have tested positive for the virus.

Lee defended the information only being made available to law enforcement and not other front-line workers, such as grocery store employees who also must interact with possible coronavirus patients, by saying that officers are “required to come into contact with these people.

“We know that first responders are required to and law enforcement are required to come into contact with these people as part of their job,” Lee said. “That’s why Health and Human Services gave that guidance to states and that’s why we’re implementing that.” to focus on offering officers proper protective gear as a way to keep them safe.

“Protecting the health of first responders is certainly an important priority. However, as public health experts have noted, disclosing names and addresses of positive cases does not protect first responders, as many people have not been tested and many people who do carry the virus are asymptomatic,” Weinberg said in a statement.

“Disclosing the personal information of individuals who will never have contact with law enforcement raises fundamental concerns about privacy without yielding a significant public health benefit. It is incumbent that any government policy implemented during the pandemic be grounded in science and public health and be no more intrusive on civil liberties than absolutely necessary.”

Doctor Do Little

Below are several articles about Nashville’s health care industry and to say they are not healthy are an understatement.

Music City in between drawing Conventions and Bachelorsluts is largely a health care city.  Vanderbilt combing the Hospital (a entity of its own) and the University is the largest employer and then the hospitality trade, Ryman Group, are also large players and in turn so is Nissan and Bridgestone for what it is worth are in the top 10.  The varying hotels and businesses that cater to hospitality are of course the most significant under-liar in the core of employees and we have seen that industry take a huge hit of furloughs and layoffs.  Only Las Vegas tops the list of that area followed by the larger tourism capitals which includes New York and New Orleans.   There is no counting across the country about that particular industry and how bad it is hit now and will be coming forward.

But the medical industry deserves special attention as that is largely the main contributor to the white collar industry that makes an economy diverse and is used to attract the like so in this case as Nashville tried to once again pivot and reinvent itself it was that business that gives a pretty face to the truths, that it is a city of largely young, ill educated and poorly trained workforce.  But by adding the data from the medical and the legal field (again it is state capital and that inflates those numbers artificially as well) it gives a higher median income in which to present a nice package of lies.  And no one lies like a Southerner.

Two are filing for Bankruptcy, one has furloughed staff, a CEO has taken pay cuts and one is selling off hospitals to meet analysts needs.

Again we have had a problem with regards to medical care for decades, from the vulture capitalists buying up practices and hospitals, to the closing of rural facilities and lastly public funding for public health has all lead up to this – a shit storm.

The crisis in public health can be told in this story from the New York Times from a public hospital in Ground Zero of the pandemic.  Just yesterday a Doctor from New York who contracted Covid after treating patients decided to end her life.  So as I watched Doctors and other “front line”workers comment and share their grief one comment stood out: “I did not sign up for this.” Well bitch, yes you did.  When you entered the medical profession that oath “First Do No Harm” was one you took and yet repeatedly over the years we have heard one horror story over another about the failures of the medical system to protect and not do harm. The endless stories of fraud and malfeasance over Medicaid and Medicare are like legionnaires disease.  Or did you know that Medical Malpractice is the third highest cause of death in the nation?  So now you are in the middle of a major pandemic.  When did you not learn or know of these as they have been happening in this lifetime we just have been lucky – until now.

So again I am not out applauding, go funding or giving one flying fuck about their well being as they have proven time and time again they selectively do so using factors as age, gender, wealth and color to make the life and death panel decisions and are doing so now.  We will never get true and accurate numbers about any of this let alone from hospitals about what is going on there.  They were run for profit and run now into the ground by a storm that makes an F4 (gotta love the F) Tornado seem like a stiff breeze.

Tennessee home of the industry Core Civic that runs prisons and are Corvid outbreaks vs the other kind and of course the Life Care Centers old folks homes that one was ground zero in Kirkland, Washington; their numbers are spread all over the country.   Tennessee is a right to work state that prohibits unionization, collective bargaining, they have incredible OSHA issues on a normal basis, but now especially with Covid, and they have massive other problems that they ignore or simply lie about (all of which I have written about extensively on this blog).  Their own Nashville General Hospital in Nashville had its own controversies and issues  much like the one in the story from New York and this is the same in Harborview Medical Center in Seattle.  Until this massive storm hit we just thought its all good as it ain’t happening to me.  Well in some way even if you did not contract Covid you caught the side effects.

We did this, we need to fix this, we need a single payer health plan and we need to fund health care across the board fairly and equitably and in turn follow that with education.  Private money can go fuck itself when it comes to the greater good.  And this is neither great nor good.

So as you glance at the finances I think we can see how we got here on a slow moving bus across a train track and the train is coming. Bottom line is that money spent on health care needs, fully staffing, training, have necessary equipment and of course allocation for emergent situations are not available to the masses and why the red tape and bureaucracy made this worse. Well we were asleep at the wheel and Jesus was already driving the bus.

Report: Another massive Nashville health care company considers bankruptcy

A second Nashville health care company this month could be headed for Chapter 11.

Envision Healthcare Corp. has hired restructuring advisers and is considering filing for bankruptcy, according to a Bloomberg report. The company is struggling financially as government regulations banning elective surgeries due to COVID-19 in most states have left Envision with few options to manage its $7 billion of debt, according to “people with knowledge of the matter.”

Envision was bought by private investment firm KKR for $9.9 billion in 2018. At the time, Envision was Middle Tennessee’s third-largest publicly traded health care company, with $7.8 billion of revenue in 2017. The company employs more than 25,000 clinicians in 45 states.

Envision is led by President and CEO Jim Rechtin, who was appointed to the job in February, just days before the COVID-19 crisis took hold in the U.S. He replaced long-time CEO Chris Holden.

Envision did not immediately respond to a request for comment.

Envision has experienced a significant decrease in patient volume during the pandemic, across all practices and specialties, according to a news release earlier this month, with decreases as high as 70% in anesthesia services and ambulatory surgery. Despite the influx of COVID-19 patients in certain areas of the country, emergency department visits are down 30% overall.

To counter those headwinds, Envision’s senior leadership team took temporary 50% salary cuts. Non-clinical employees have also seen temporary salary reductions as well as furloughs; in areas where patient volumes are low, clinical compensations were also be reduced.

In addition, performance bonuses, clinician profit sharing, retirement contributions, merit increases and promotions were temporarily suspended for all employees.

Envision has hired law firm Kirkland & Ellis LLP to advise the company of its restructuring options, including a potential Chapter 11 filing, according to the report. The sources said the situation could change depending on the length of the shutdown of elective surgeries and market conditions.

Envision’s debt has been trading at low levels, according to the report, with $1.23 billion of bonds due in 2026 trading for 30 cents on the dollar last week. The company’s lenders have hired their own advisers to negotiate with the company, according to the report.

Earlier this month, Brentwood-based Quorum Health Corp. filed for Chapter 11 bankruptcy in the U.S. Bankruptcy Court for the District of Delaware. As part of the filing, Quorum and its lenders entered into a restructuring support agreement, or RSA, featuring a “pre packaged” plan to reduce the company’s debt by $500 million and recapitalize the business.

———————————
Nearly five years after being spun out of Community Health Systems Inc., Brentwood-based Quorum Health Corp. has filed for Chapter 11 bankruptcy.

The filing was made Tuesday in the U.S. Bankruptcy Court for the District of Delaware, according to a news release. As part of the filing, Quorum and its lenders have entered into a restructuring support agreement, or RSA, featuring a “pre packaged” plan to reduce the company’s debt by $500 million and recapitalize the business.

Quorum and its hospitals will remain open and employees will continue to get paid, according to the release.

“We believe the financial restructuring plan announced today will strengthen our business and enable our community hospitals to continue the important work they are doing in addressing the COVID-19 crisis, as well as serve their patients and communities,” Quorum CEO Bob Fish said in the release.“Quorum Health has been transparent about the need to restructure our debt over the past year. We believe the RSA will significantly reduce our debt and annual interest expense and better position our company, our affiliated hospitals, and our hospital management and consulting company, for future growth. The RSA will also build on the significant progress we have made to strengthen our operations. We are grateful for the support of our financial stakeholders, which we believe represents a statement of confidence in our business and enables us to move through this process on an expedited basis.”

Quorum (Nasdaq: QHC), which has 12,000 employees and was spun out of CHS in 2015, is one of Nashville’s 10 largest publicly traded health care companies, according to Nashville Business Journal research, with $1.8 billion of revenue in 2018. The company has yet to file its 2019 earnings report.

The 24-hospital company has struggled financially over the past 18 months, fighting to buoy its share price as it sells hospitals to pay off debt. The company has received three delisting warnings from the New York Stock Exchange in the past year due to the company’s share price trading at less than $1 over a consecutive 30-day trading period and because its average market capitalization was less than $50 million over a consecutive 30 trading-day period.

Shares of Quorum were trading at 30 cents per share Tuesday morning, giving the company a market cap of $10 million.

Quorum had been considering a proposed recapitalization and buy-out of its public stock at $1 per share from private equity giant KKR, which owns more than 9% of Quorum’s outstanding shares and is the largest holder of its debt.

—————————————————-

Nashville health care stocks are taking a beating from COVID-19.

HCA Healthcare Inc.’s stock price has lost nearly half if its value since its 2020 high of $151.04 per share, dropping 48.7%, to close at $77.46 per share Tuesday. Shares of HCA haven’t traded that low since November 2017.

HCA is not alone as stocks across industries have plummeted in recent days due to fears and precautions taken to slow the spread of coronavirus across the U.S. On Monday, the Dow Jones dropped 12.9%, its worst percentage drop since 1987, while the S&P 500 dropped 11.9% and the Nasdaq fell 12.3 %.

Many of the companies inside Nashville’s $46.7 billion health care industry are on the front lines of efforts to stop the spread of the virus and care for patients who fall ill from COVID-19.

HCA (NYSE: HCA) is the nation’s largest hospital operator, with more than 180 hospitals and 2,000 sites of care. Brookdale Senior living Inc. (NYSE: BKD), whose residents are particularly vulnerable to COVID-19, is the nation’s largest senior-living community operator, with more than 750 facilities in 45 states.

The List
Largest Public Health Care Companies in Nashville
Ranked by Revenue 2018
Rank Name Revenue 2018
1 HCA Healthcare Inc. $46.68 billion
2 Community Health Systems Inc. $14.15 billion
3 Brookdale Senior Living Inc. $4.53 billion

Brookdale’ stock price has also been hit hard due to COVID-19, dropping more than 76% from its 2020 high of $8.39 per share, to close at $1.99 per share Tuesday.

A little more than a month ago, SmileDirectClub’s (Nasdaq: SDC) stock was trading at $15.33 per share. The company’s stock closed Tuesday at $4.89 per share, a 68% drop.

Acadia Healthcare Company Inc. (Nasdaq: ACHC), Community Health Systems Inc. (NYSE: CYH), Change Healthcare Inc. (Nasdaq: CHNG) and Quorum Healthcare Corp. (NYSE: QHC) have all seen their share prices drop by more than 50% from their 2020 highs.

While analysts expect most stocks across industries to eventually recover their losses, no one is sure how long the bear market will last.

“I’m buying a lot of things including bank stocks, although I own a lot of banks. I do think it’s an opportunity. I think we’re likely to have a recession, but I think it’s going to be V-shaped. This is all about the virus,” former Wells Fargo CEO Richard Kovacevich said in a CNBC report. “I mean, we’re talking about markets and so forth, but job No. 1 is we have to get this virus under control. We know how to do it. Other countries have done it. And it can be solved relatively quickly. [There] may be a lot of disruptions in our lives to do that, quarantines and so forth, but this is not a financial crisis. It’s not a banking crisis. It’s a health crisis.”

________________________________________________

Franklin-based Community Health Systems Inc. is selling a trio of Southern hospitals.

CHS has agreed to sell the 231-bed Abilene Regional Medical Center in Abilene, Texas, and 188-bed Brownwood Regional Medical Center in Brownwood, Texas, to Hendrick Health System, according to a news release.

CHS has also agreed to sell its 84‑bed St. Cloud Regional Medical Center in St. Cloud, Florida, to Orlando Health, according to a separate news release. Orlando Health already held a minority ownership interest in the medical center and will purchase the remaining portion through the deal. Terms for both deals were not disclosed.

CHS (NYSE: CYH) is Nashville’s second-largest publicly traded health care company, with $13.2 billion of revenue in 2019. The company has closed, sold or agreed to sell more than 90 hospitals since 2017 to pay off debt incurred as a result of its $7.6 billion purchase of Florida-based Health Management Associates in 2014.

Tennessee hospitals, many of which were struggling prior to the Covid-19 pandemic, are losing approximately $1 billion per month during the crisis, according an analysis conducted by the Tennessee Hospital Association.

The state’s hospitals typically generate $1.7 billion of revenue per month, according to a news release.

Last month, Gov. Bill Lee banned elective surgeries at health care facilities across Tennessee in an effort to conserve dwindling medical supplies. Those surgeries, such as knee replacements, typically have higher margins than other medical procedures.

“Tennessee hospitals have taken all of the appropriate steps to conserve resources and create capacity for COVID-19 patients,” THA President and CEO Dr. Wendy Long (who is a member of Lee’s Covid-19 task force) said in the release. “These facilities have maintained expensive operations in preparation for and to serve Covid-19 patients while experiencing a dramatic drop in volume and services that typically comprise their core business. This creates a paradox of hospitals experiencing severe financial strain when their services are most needed.”

Across Tennessee, hospitals have had to adjust to the decrease in revenue, with several systems such as Williamson Medical Center furloughing workers due to reduced patient visits.

In early April, Nashville-Based HCA Healthcare Inc., the nation’s largest hospital operator, announced its senior leadership would take a 30% pay cut until the pandemic subsides to avoid layoffs, with CEO Sam Hazen donating the next two months of his salary to HCA’s charitable fund. Last week, Boomberg reported than Nashville-based Envision Healthcare is considering several options, including bankruptcy, as it struggles with decreases as high as 70% in anesthesia services and ambulatory surgery.

“In 2018, 71 hospitals in Tennessee had operating margins that were 2% or below, and 60 had zero or negative operating margins,” Dr. Long added. “It doesn’t take a pandemic to stress the system, and Covid-19 has made the situation much more difficult for many of our hospitals.”

The state has deployed $10 million to help rural hospitals survive the pandemic. The federal CARES Act has more than $100 billion reserved to help the hospital industry, although it is not clear how much of that will go toward Tennessee hospitals.

During its first quarter earnings call last week, HCA said it expected to receive approximately $4 billion in accelerated Medicare payments thanks to the CARES Act.

“Recent funding opportunities for hospitals that are being made available at the federal and state levels are very much appreciated lifelines to this vital industry,” Long said in the release. “However, the reality is the impact is so massive that more assistance will be needed in order to ensure continuity of operations at hospitals and provide a necessary level of care. Now more than ever, Tennesseans need their hospitals to remain open and caring for their community.”

The Care Part

As the Affordable Care Act still goes along with many bumps and bruises along the way the idea is that it will all be okay as more Americans will be getting care for those bumps and bruises.

Well on that front we have found that the idea of signing up for healthcare is much like voting – a provenance for the oldsters. What should be across the board enrollment especially what is needed to offset costs via the young, the largest uninsured group, is in fact not happening. It is us or my cohort, the boomer tails. We are those 45-54 who are classifed as the United States biggest problems, too old to work and too young too die. Yep we are just biding our lazy ass time waiting for the big payoff of Medicaid and Social Security. Out of my way young punk I got me some sitting around on my as while you work to pay for it… or however the misconception bullshit that perpetuates as logic or excuse making goes in politics.

Then we have the issues of the subsidies. Well those passed another round in the Courts today and well if you are poor and you know it but not poor enough to be a full on charity case and get Medicaid, the second largest group of enrollees under Obamacare, you will qualify for a federal subsidy.

And then now finally with that precious gem of a card finally in hand you now can get the medical help you could have had the first time, charity care.

Most of the plans offerred through state or federal exchanges have one option of Hospital care and of course Doctors with admitting agreeements at said Hosptials and that is of course the public ones.

Here in Washington State there are out of the 5 options of insurance providers only two that have more than one choice of hospital care. Group Health an HMO with their own crappy hospitals and the other the State run program that has existed all along and has public clinics which you must first go to before actually going to see any provider at the other hospitals that exist in the area. Bet you 5 bucks that regardless you are not going to any of those, consider them last resort over the public and state run University hospital system or aka the “public option”

So I can get insurance now, the same insurance I had before with less choice. I will be going to Harborview/University of Washigton abuse system of health or well nowhere unless pitching a bitch works.

The article below discusses this as it relates to New York. But be certain that is everywhere as the public option is going to the place you tried to avoid even when you didn’t have insurance. God help us everyone and Tiny Tim too. Maybe that was why the kid was crippled in the first place, crappy medical care.

Public Hospitals Hope to Attract More Upscale Patients Under Affordable Care Act

By ANEMONA HARTOCOLLIS
JAN. 15, 2014

Todd Obolsky lives in a studio apartment in Manhattan, drives a leased Toyota Corolla and occasionally splurges on experimental cuisine in the East Village. When the Affordable Care Act allowed him to buy insurance for the first time in years, he was so price-sensitive that $30 a month made a difference in which plan he picked.

So the obvious choice was MetroPlus. It offered the best deal at the coverage level he was looking for — about $400 a month for a gold plan, the second-highest of the four levels. “That’s like as high as I can possibly go without living on rice,” he said.

He never noticed that it was the insurance company of New York City’s public hospital system; to a typical shopper on New York’s health exchange, it looks no different from big-name companies, like Empire or United.

But to the Health and Hospitals Corporation, the city’s public hospital agency, it is not merely another insurance plan. The corporation created MetroPlus, and sees it as a powerful opportunity to attract a different class of patients — somewhat higher-income, more educated and more stable — to a system whose historic mission has been to serve the poor, and whose finances have been straining.

Robyn Chapman, an artist, signed up with MetroPlus as well. The hospital system is hoping to attract more affluent patients. Nicole Bengiveno/The New York Times “It’s a potential significant source of additional revenue,” said Alan Aviles, the corporation’s president. While “we won’t necessarily have concierge services; there won’t be a piano in the atrium,” he said he hoped the new customers would find that his hospitals were underrated.

Around the country, a number of public health systems and charity hospitals serving large numbers of poor patients see the health exchanges, created by the states under the act, as a way to widen their customer base. In Los Angeles, L.A. Care, a publicly run health plan, has enrolled about 8,000 people so far via the California exchange. The Henry Ford Health System in Detroit, which has roots in organized labor and the auto industry, has signed up about 4,000 people in its exchange plans.

The University of Arizona Health Plans have attracted only 250 people, said James Stover, their chief executive. But he said they were still trying to sign up young people who were part of the university system, as well as uninsured people on the cusp of Medicaid eligibility, who are partly responsible for the system’s $100 million a year in uncompensated care. “It makes a lot of sense from a mission standpoint to go into the marketplace and try to find coverage for these individuals,” Mr. Stover said.

By Dec. 24, the deadline for receiving coverage on Jan. 1, MetroPlus, one of 10 companies selling exchange plans in New York City, had enrolled 18,397 members, about 32 percent of all those who signed up citywide. Enrollment hit 22,000 last week, the corporation said, and it hopes to reach 40,000 by the end of 2014.

Currently, only 7 percent of the 1.4 million people treated by the city’s public hospitals each year have private insurance, according to the Greater New York Hospital Association. Another 58 percent are on Medicaid or Medicare, and 35 percent are uninsured; half of those are illegal immigrants, who cannot get coverage under the new law.

That patient mix fosters a common belief that the public hospitals are a last resort, or as one Yelp reviewer described Woodhull Medical and Mental Health Center in Brooklyn: “If you were writing for a TV drama about the downtrodden castoffs of society, you could not have conceived of a more appropriate place.”

In the Medicare system’s Hospital Compare ratings, the city’s public hospitals typically score lower in patient satisfaction than private ones. But they compare well on medical measures, like whether they follow protocols for heart attack, pneumonia and surgery patients.

For years, the hospitals corporation has tried to polish its image by contracting with private hospitals and medical schools to staff the public hospitals; for example, many Bellevue doctors come from NYU Langone Medical Center next door. And by attracting more affluent and choosy customers, the corporation hopes, it can also attract doctors into the MetroPlus networks who would not normally associate with public hospitals.

MetroPlus was created in 1985 as a managed-care plan for Medicaid recipients. While there is no guarantee that offering MetroPlus on the health exchange will be profitable, the corporation projects that the exchange plans will bring $120 million a year in revenue to a system now running a $250 million annual deficit.

By this week, 66 percent of its customers were enrolled in the silver plan, suggesting that they had low to moderate incomes and expected to qualify for subsidies. But 10 percent enrolled in gold and 18 percent in platinum, suggesting higher incomes, which surprised MetroPlus officials.

As Mr. Obolsky discovered, MetroPlus offers the lowest premiums on the New York exchange for the top three standardized plans: $359 a month for silver, $396 a month for gold and $443 a month for platinum.

One major reason for the low prices is that MetroPlus will cover patients only at the city’s 11 public hospitals and four private ones — Beth Israel’s two campuses in Manhattan and Brooklyn, St. Luke’s-Roosevelt in Manhattan, and Lutheran in Brooklyn. Except in an emergency, plan members will not be covered at some of the more prestigious hospitals like Mount Sinai and NYU Langone.

Mr. Aviles said that to keep its premiums down, MetroPlus had to offer relatively low reimbursement rates for hospitals. Several hospitals said they were still negotiating with MetroPlus and might join the network.

Mr. Obolsky, 48, a consultant, said he was happy to hear that St. Luke’s-Roosevelt was on the plan, because its campuses were near him on the Upper West Side.

Robyn Chapman, an artist who pieces together a living making and selling comic books, working as a legal assistant and cat sitting, signed up for a silver MetroPlus plan. Her first bill was for $119.42 a month after tax credits.

She had not realized that MetroPlus was run by the city hospital system. But that would not have stopped her, she said, because she was looking mainly for price. She was familiar with one city hospital — Woodhull in Brooklyn — because she had used its clinics for routine medical care at $20 a visit. She said the waiting times there were very long, many patients seemed desperate and some nurses and doctors were “a bit cold, maybe even a little rude.”

She might try a different hospital, but otherwise she said: “I can’t complain. I’m honestly very grateful.”

Mark P. Scherzer, a consumer lawyer and counsel to New Yorkers for Accessible Health Coverage, said he expected MetroPlus would “still be sort of a poorer person’s plan,” with lower prices and lower quality.

Mr. Aviles conceded that for some people, public hospitals would never be acceptable, regardless of how well they delivered care.

“There’s always a headwind in terms of how many hospitals there are in New York City and how many have designer labels,” he said. “In the same way that if you’re affluent and buying a pair of jeans, you may be willing to spend $200 for those jeans because they have a designer label.”

Doctors With Borders

This has been coming. Forcing Doctors to care about their Patients. We have limits and as we have found ourselves literally breaking as a result of the constant rise in Medical care so its not shocking something other than bones have to break.  New York in an another attempt to lead the Nation in demanding shit actually is in this case doing it for the Poors instead of to them.

And while this is tied to the Affordable Care Act, there is no of course any auditing in place, actual demands and regulations either.  Like Dodd-Frank, good on paper,  but the benefits remain to be seen. Like electronic records all smoke and then it clears and the mirrors are revealed. But let’s be optimistic or not.  Remember its not that you need care its who you are and how you came in the door that matters. And already the exceptions are hitting the pavement. Literally.

The article below discusses the need for Doctors to actually care about their patients. Wow who is the Norma Rae of the AMA?  How rude and demanding.  My mother used to say those fake Fox furs cost money and the better quality ones don’t shed in the Opera. We would then laugh.  I didn’t grow up in a home with reverence over Physicians. They were necessary “evil” and that has never been more truthful of late.

As a victim of a Public Hospital, Harborview  treats the Poors in Seattle, aside from being a Trauma Center, for not just our state but 4 others.  Clearly they are stretched in limits that extend beyond their capability.  Although that could mean giving you a bandage and aspirin frankly.  See electronic medical records serve a purpose, good reading.

New York City Ties Doctors’ Income to Quality of Care 

By ANEMONA HARTOCOLLIS
Published: January 11, 2013

In a bold experiment in performance pay, complaints from patients at New York City’s public hospitals and other measures of their care — like how long before they are discharged and how they fare afterward — will be reflected in doctors’ paychecks under a plan being negotiated by the physicians and their hospitals.

The proposal represents a broad national push away from the traditional model of rewarding doctors for the volume of services they order, a system that has been criticized for promoting unnecessary treatment. In the wake of changes laid out in the Affordable Care Act, public and private hospitals are already preparing to have their income tied partly to patient outcomes and cost containment, but the city’s plan extends that financial incentive to the front line, the doctors directly responsible for treatment. It also shows how the new law could change longstanding relationships, giving more power to some of the poorest and most vulnerable patients over doctors who run their care.

“I would expect that we’re going to see this become more and more prevalent in compensation arrangements,” said Alan Aviles, president of the city’s Health and Hospitals Corporation, which runs the city’s 11 public hospitals and is the country’s largest public health system, handling more than 1 million emergency room visits a year.

The corporation’s plan would make doctors’ raises dependent on their performance on quality measures. The details are being negotiated with the doctors’ union, but both sides expect to reach an agreement that incorporates the idea.

Still, doctors are hesitant, saying they could be penalized for conditions they cannot control, including how clean the hospital floors are, the attentiveness of nurses and the availability of beds.

And it is unclear whether performance incentives work in the medical world; studies of similar programs in other countries indicate that doctors learn to manipulate the system.

“The consequences in a complex system like a hospital for giving an incentive for one little piece of behavior are virtually impossible to foresee,” said Dr. David U. Himmelstein, professor of public health at the City University of New York and a visiting professor at Harvard Medical School, who has reviewed the literature on performance incentives. “There are ways of gaming it without even outright lying that distort the meaning of the measure.”

Over the next few years, the federal government will financially reward or penalize hospitals based on how they perform on benchmarks that are believed to be correlated with better patient outcomes. By aligning doctors’ pay to the same benchmarks, city hospitals hope to perform well enough to qualify for federal bonuses.

Under the proposal, bonuses of up to $59 million over the next three years would be distributed to about 3,300 doctors, and would be given to physicians as a group at each hospital, rather than as individuals, so that even the worst doctor would benefit. They would amount to up to 2.5 percent of salaries, which range from about $140,000 for entry-level primary-care physicians to $400,000 for experienced specialists.

Dr. Bruce Siegel, president of the National Association of Public Hospitals and Health Systems and a former head of the hospitals corporation, called the plan “unprecedented for American public hospitals, in terms of scale, in terms of moving us into a new model.”

Los Angeles County, which has the nation’s second-largest public health system after New York, does not have anything similar, said Dr. Anish Mahajan, director of system planning for the Los Angeles County Department of Health Services. “What an intriguing idea,” Dr. Mahajan said. “That’s something we would hold out as a potential thing we do in the future.”

Administrators at several private New York hospitals said they were considering incorporating the federal benchmarks into their salary structures, but have not yet done so on a significant scale.

The public hospital system has come up with 13 performance indicators. Among them are how well patients say their doctors communicate with them, how many patients with heart failure and pneumonia are readmitted within 30 days, how quickly emergency room patients go from triage to beds, whether doctors get to the operating room on time and how quickly patients are discharged.

Union officials said they were still fighting for wage increases, in addition to performance bonuses. The union has also proposed expanding the indicators to 20, including measures that would give doctors bonuses for going to community meetings, giving lectures, getting training during work hours, screening patients for obesity and counseling them to stop smoking. It has also proposed excluding some patients — like developmentally disabled patients, homeless people and those who have no place to go — from incentives aimed at reducing the time patients spend in the hospital.

A union official, who spoke on the condition of anonymity so as not to upset negotiations, said doctors considered the proposal demeaning. “To say we’ll stick a carrot in front of you and therefore you’re going to be a better doctor is a little disingenuous,” he said.

In a written statement, Dr. Barry Liebowitz, the president of the union, the Doctors Council S.E.I.U., said it supported performance incentives in theory, if they “will improve patient care.” But he called for a team approach and hinted that the union would demand more doctors and support staff.  The traditional physician incentive payments, tied to the income they generate for hospitals, have been roundly blamed in recent years for driving up costs. (The hospitals corporation had not used these incentives but, in some cases, had required doctors’ groups to meet minimums for billing.)

Studies have found that they can lead to excessive testing and “upcoding,” or diagnosing ailments as worse than they really are, to justify more patient treatment and higher payments. Mr. Aviles said the corporation’s plan would not tie payment to the volume or intensity of care. But Dr. Himmelstein said there were still hazards in the city’s plan. He said that when primary-care doctors in England were offered bonuses based on quality measures, they met virtually all of them in the first year, suggesting either that quality improved or — the more likely explanation, in his view — “they learned very quickly to teach to the test.” “I think the most interesting finding is, things that were not measured, in a few studies, appeared to have gotten a bit worse,” Dr. Himmelstein said. For instance, patients were not as likely to stick with the same doctor, possibly because they were encouraged to see whichever doctor was available — speed was one quality measure — rather than the doctor who might know them best. In another example, while the doctors reported that they had controlled blood pressure in virtually all their patients, a random survey showed no downward trend in blood pressure or strokes. There could have been any number of ways of outsmarting the system, he said: “If you take blood pressures three times and report the lowest, is that lying or merely tipping the numbers in your favor?”

 Dr. Himmelstein also said doctors could try to avoid the sickest and poorest patients, who tend to have the worst outcomes and be the least satisfied. But physicians within the public hospital system have little ability to choose their patients, Mr. Aviles said. He added that he did not expect the doctors to act so cynically because, “in the main, physicians are here because they are attracted to that very mission of serving everybody equally.”