Accounting for Healthcare Expenditures - What $ Comes in Under the Radar? Micro Look at Community Hospital Stats

National stats on how healthcare spending will break the American piggybank wide open are easy to find.

Let's take a micro-look at how healthcare costs, utilization, and budgeting are affecting small-town USA, and how even in the non-profit hospital space, significant monies flow in and out through various donation, gift, and other channels. Here's what keeps me up at night when I read the latest release about the stimulus bill budgeting...

Spending is never quite what it seems on the healthcare balancesheet, not from the individual perspective, and not from the systemic perspective.

Exhibit A: St. Mary's Hospital of Maryland. I worked there as a Patient Advocate my senior year of undergrad.

Quick disclaimer - I've also received excellent post-trauma care at the hospital, and still count that job as one of my favorite to date. Because it supports so many in my community (including most of my immediate family), I follow its activities from afar.

I just received their latest edition of "Healthy Living," a community-oriented print newsletter.

A quick and dirty read of the newsletter reveals these interesting stats about costs/expenditures we're counting (or not counting) in HC:

* breast cancer accounts for approximately 33% of all cancer Dx (and on the rise), leads to purchase of breast coil for one MRI machine, also new 64 slice CT scanner - where is condition-specific research influencing how we budget for healthcare acquisition of equipment, personnel, and thus incentives for R&D, training, recruitment, education, etc?

* volunteers (unpaid employees) donated more than 7k hours over past fiscal year, and made over 5k 'pastoral' visits...it's home health with a religions/faith-based bent, and is accounted for nowhere on the balance sheet - where's the DRG for this? By what percentage is our national healthcare spend REDUCED via volunteerism and donated time? How will the graying of the boomers, increased workloads, and rising sedentary lifestyles REDUCE future volunteerism in the healthcare space?

* The hospital's Annual Gala was sponsored by Wyle, Alliance Anesthesia Associates, AMEWAS Incorporated, Associates in Radiation Medicine, Eagan McAllister, IAP World Services, ManTech Systems Engineering Corp. This is smorgasboard of pharma, HC, and defense/contracting players (community-based since we live near Patuxent Naval Air Surface and Warfare base PAXRiver). Raises $175k for Foundation Scholarship program, aka recruit and pay for education of future employees. By what percentage is our hospital's ability to recruit INCREASED by gala/fundraising activities? How will this be affected by recessionary/depression related pressures?

* St. Mary's Hospital Auxiliary group raised $15,1000 for mobile EKG machine for ER (Aux. donated more than 4.3 MILLION in gifts since 1970). What percent of our hospitals' budget lines are raised by auxiliary groups? How do they contribute to HIT, EMR, etc. spending, if at all?

* According to 2005 data (!), 13.4% of people UNDER 65 were uninsured in St. Mary's County. A rise in the uninsured (and underinsured) populations affects spending how? What percentage of nonprofit assistance programs jump in here and contribute? How do we quantify that?

* For FY 2008 (1 July 07-30 June 08), the hospital provided more than 3M in 'charity care,' at reduced or no cost. How do increases in charity care provided affect the bottom line nationally?

* SCARY: "The hospital saw a 68% increase in individuals utilizing (not applying for, USING) the hospital's Payment Assistance Plan from fiscal year 2006 (!) to fiscal year 2007." A financial assistance counselor is cited as saying that "over the last six months she has seen an increasing number of individuals who fall within the middle-class designation (according to Federal Poverty Guidelines) requesting help. How will time spent with patients counseling them on payment alternatives change the face of daily business and operations at our hospitals? Will we outsource this? Do we quantify it?

In other words, how much is counseling people about how to pay for their healthcare REALLY costing us?

Posted via web from Jen's posterous

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