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Posted 1:42 pm, 05/23/2017

p until 1982- 1983 Medicare basically paid based on the cost to provide care, unfortunately Hospitals and Healthcare companies utilized Federal money to build, and build and build, because they knew that a certain percentage of the cost could be passed onto the Medicare system. That all changed with the industry moved to the DRG system, basically 690 codes with a variety of modifiers to describe what was wrong and what was done for the patient. Averages were determined for broad regional areas and a standard payment amount was determined. Over the years payment rates have been reduced as opposed for keeping up with inflationary costs to provide care. Over 50% of the hospitals in the United States have a negative margin caring for Medicare patients, Medicaid is much the same. For many hospitals well over 50% of the business is no longer paying the actual cost of providing care, thus you find facilities needing to request assistance from some sort of taxing authority to maintain operations.

The Board Members of the hospital are selected by the Shareholders of the Hospital during their annual meeting each year. Shares of stock used to cost $100, not sure what they are now. There are about 600 shares outstanding. You have to be a shareholder to be on the Board, there are no provisions for an ex-officio board member such has been suggested in previous posts. The Hospital articles of Incorporation could be changed and suitable bylaw revisions made to accommodate a seat for a county commissioner, but as has been mentioned you can see how well that has turned out in the past for other organizations where there was a commissioner seated on a Board.


Posted 8:48 pm, 05/22/2017

Blowing Rock was interesting though because they had donors, but it wasn't worth keeping it afloat.

Cannon had donors but also has a very profitable behavioral health unit. Most of the services are being moved to Watauga except for the behavioral health and critical services.


Posted 8:41 pm, 05/22/2017

But that was because town residents were comfortable with combining with watauga hospital in Boone. But Cannon in Newland exists only because the big money around it kept it going.


Posted 8:24 pm, 05/22/2017

Proximity to Boone was a huge reason, but Blowing Rock Hospital could not make it and it sitting in the middle of money.


Posted 7:47 pm, 05/22/2017

I remember about 20 years ago the hospital in mountain city went backrupt and shut down. Everything was sold off at a bankruptcy auction. A couple citizens bought it all back, building, land, beds, equipment, all of it and gave it back to the county. The county brought in the hospital out of Johnson city to run it, and the Johnson city hospital made the decision to shut it down and replace it with basically an urgent care with an ER.


Posted 5:12 am, 05/22/2017

That's pretty sad that a hospital is in that shape Clod, I'm glad at least we are supplying ours with needed funding to keep it going, I'd hate to lose ours.


Posted 2:40 pm, 05/21/2017


Posted 11:39 pm, 05/20/2017

FINS I do agree that the period of instability between a pullout and market reset would be bad. Ultimately care would be cheaper in the long run. But they aren't going to pull out. Hopefully the Senate improves the AHCA or it'll make health care pretty much unaffordable for many before they pass it. Ultimately though if we aren't repealing the ACA there is no reason to really even pass the AHCA.

The ACA has worked well for those making up to 250% poverty level due to the subsidies that reduce out of pocket and deductibles as well as premiums. It has largely hurt those making from 251% to 400% of poverty level making out of pocket and deductibles rise drastically. However the ACA allowed subsidies up to 400% of poverty level, its just the GOP House refused to give sufficient funding to achieve that so Sec. Sebelius had to make the cut off 250%. Just provide the additional funding, but I still think the better solution is to combine all the federal programs into 1 program, that means touching Medicare, Medicaid, Tricare, etc. It would take more courage than Congress possesses but it would fix many of the problems particularly if you actually removed employer mandated health care. In fact I think the ACA may have been designed to move towards such a system as it was designed never to work, you can't have enough healthy young people sign up if you allow those up to 26 to stay on their parents plan.....it's a poison pill meant to kill the bill, but is so widely popular the bubbling fools of Congress would never remove or lower that age.....

As for drugs that's going to be a problem and is a bubble. It's amazing how mom's insurance changes which insulin they will pay for year to year, almost crazy, what's funny is they flip flop between two the last three years. I've seen ads for pet meds but it is crazy.


Posted 2:43 pm, 05/20/2017

Today, for the first time, I saw a drug commercial for a veterinary drug. Maybe this has been going on for a while, but it's the first time it caught my attention. But i couldn't help but think how screwed up the pharmaceuticals industry is.


Posted 2:16 pm, 05/20/2017

And pharmaceuticals it truly a bubble waiting to burst.


Posted 2:14 pm, 05/20/2017

You are absolutely correct, but that's also a fault of the doctors sometimes due to incorrect coding. Most of the time its exactly how you describe it. That's happening in the private insurance as well.


Posted 1:52 pm, 05/20/2017

Heels, I think the way Medicare dictates patient care is more of an issue than how they pay. I've seen in several cases where they wouldn't let a doctor go with a treatment or run a test before doing another treatment or test first. In one case a doctor wanted an MRI on a patient, but Medicare said they had to do X-rays first. All it did was increase the final cost and drug out diagnosis and treatment.


Posted 1:46 pm, 05/20/2017

One thing people don't realize is Medicare has not stopped paying, they have stopped paying for excessive billing. In the past doctors and hospitals overcharged medicare to cover the uninsured and bad debt. Now if a hospital is caught overcharging they are penalized. Essentially they have to be within a percentage of the average cost of that procedure. Medicare is not dictating cost, but they are making sure the prices are reasonable when compared to your peers. Take a Lab test, in 5 years if you are above the average price of the test, you have to pay the government back the difference. Now that can get expensive, so hospitals and doctors have to do their homework. So yes reimbursements are down, but no it's because of competition in the market that drives that cost lower. Now Medicare is paying similar prices to the insurance companies.

Medicare makes up over half of the Healthcare industry, ask any Healthcare professional, you don't ignore the largest market share of customers, it does not matter how much paperwork there is.


Posted 11:40 am, 05/20/2017

Jr, the problem with removing government from paying for health care is the market correction that would happen. Between government stepping away, and the point where prices adjust, many people would lose all coverage. Also, many hospitals and other providers would collapse. The fallout would be very painful. And this is assuming that quality of care would not drop when it's all over. Currently we have a range in care quality. But it's a range from better to best. If health care went completely free market, I'd be concerned it would range from barely passing health codes to top shelf.


Posted 10:33 am, 05/20/2017

The problem is we haven't had a free health care system since 1966. The free market only works if both sides can walk away. Medicare made that impossible demanding hospitals and/or doctors provide care in exchange for Medicare paying out, and as time has gone by Medicare has squeezed them more and more.

Medicaid as it is today is an abomination really, providing almost no care it's payouts are so low that fewer and fewer places are taking it, I've heard the paperwork isn't worth the payout for it. In a way NC Legislature did the state a favor by not expanding it.

The US Government also runs Native American Care, they have a saying don't get sick after June (after all Congress has underfunded it for 100 years). It also runs the VA, which has those horrible death lists, bad care and many veterans like my dad refused to go to it, choosing just to suffer rather than put up with the indignation (until they died).

About the only two US Government run health care systems that work are Tricare, and the federal employee health program. (which is largely based on Obamacare, but they all get gold benefits and guess who's paying for it, not them.....).

I'd love to see the Government step away and stop providing health care, you'd be surprised how much cheaper it would get, it's kinda like how the Feds back student loans, make it so you can't bankrupt on student loan debt, and then give tens of thousands of dollars to 20 somethings that they have no realization that essentially will make them indentured servants for life.

Sadly that's not going to happen. Even the GOP that ran for 7 years on repealing the ACA, isn't repealing it. They kept pretty much its framework, reshuffled the deck and well it'll be a disaster if the AHCA passes the Senate, but one things for sure they are never going to pull back government control over this area. If they can't do it now they never will. Since it's obvious they aren't going to, it's time to realize that seven competing Federally run health programs will never work well, it's time to move to one system and while doing it remove employer mandated health care. Is it fair, no not really, but ultimately it's probably the only way to go at this point since they've completely failed in what they campaigned on (honestly I called them out over the last 7 years because I knew they were doing a dog and pony show....its just like all those investigations into Hillary that never went anywhere and now they'll keep us distracted with investigations of Trump that go no where, anything to distract us from the fact they do nothing.)


Posted 8:57 am, 05/20/2017

Medicare was passed by promising doctors that they would still determine how to treat their patients and set their own prices. That lasted for about 10 years until doctors figured out how to abuse the system for easy money. The free market works well when both sides negotiate price before service or goods are exchanged. But the problem with the medical industry is services are performed then prices are discussed. The doctor can't take services away if the insurance company or Medicare doesn't pay what he thinks his service is worth.

I don't know what the best solution is, but eventually we are going to end up with a single payer system. Unfortunately, we Americans (myself included) are so defensive about protecting our capitalism, I expect we will screw this up more than any other nation by trying to keep private insurance companies involved.


Posted 8:35 am, 05/20/2017

In the Post article jrscott linked, the only user that really needs the longer runway for the multi-million dollar business jet also provided $100,000 to the hospital. Wilkes has the same thing, mainly for Window World's jet. Only a few miles apart as the jet flies, or even a vintage Cessna that could fly off a short, grass strip.

Even the large, regional hospitals are feeling the heat. As private health care insurance disappears for the working masses, so do the payouts from non-private insurers.

I really noticed the difference in what the health care facilities received when I transitioned from company insurance to Medicare, even with a supplement. To me it looks like a WalMartization type assault on the health care industry. Medicaid is a really nasty payer.

I decided to live in town partly due to access to a hospital. Way up off Big Horse is not as attractive when the chest pains hit. Without a hospital, even the Jefferson's are less attractive.

A number of my extended family members work in health care. Even the large regional urban hospitals down the mountain have eliminated the old pension plans and other employee benefits. Highly trained health care professionals with only a 401K. Even though educational institutions have churned out legions of nurses for decades, many burn out and leave. Or, get that Master's degree (MSN) and go teach nursing at a state institution. Better benefits and less pressure. Or get that degree to move into management or anything away from direct patient care.

By comparison, local gov't and education employees, under much less strain still have the good old benefits. They are next to come under fire, and already have.

No wonder there is so much fighting and scrambling to get and keep local, taxpayer supported career jobs with benefits unavailable through private enterprise.

Hey, maybe someone could get a law enforcement job and move to Ashe?


Posted 10:50 pm, 05/19/2017

Clifton without taxpayer dollars there would be no hospital. As pointed out that would cause the second home market to crash. It would also see the factories we have left leave (GE, Chemi Con etc). It would be a disaster.

We can live as a county without that airport but we can't do it without the hospital.

jack rip her

Posted 8:23 pm, 05/19/2017

Clappy cliff are so ignorant that you have sat back for years and watched the mouth breathers dump tens of millions in that airport that is of no benefit for the county but you are against the hospital getting 400K. You must be a special kind of stupid. And just what does the politics of the trustees have to do with it.


Posted 5:27 pm, 05/19/2017

If the hospital operated in the positive, the ones complaining about it getting tax money now, would complain over it being in the black.

As for a commissioner on the board, New River Mental Health had a commissioner from each county it served on the board. We saw how well that worked.

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