A job engine sputters as hospitals cut staff

[hue]

http://www.usatoday.com/story/money/business/2013/10/13/hospital-job-cuts/2947929/

Hospitals are cutting thousands of jobs, undercutting a sector that was a reliable source of job growth, even through the recession.

Hospitals, a reliable source of employment growth in the recession and its aftermath, are starting to cut thousands of jobs amid falling insurance payments and in-patient visits.

The payroll cuts are surprising because the Affordable Care Act (ACA), whose implementation took a big step forward this month, is eventually expected to provide health coverage to as many as 30 million additional Americans.

"While the rest of the U.S. economy is stabilizing or improving, health care is entering into a recession," says John Howser, assistant vice chancellor of Vanderbilt University Medical Center.

Health care providers announced more layoffs than any other industry last month — 8,128 — mostly because of reductions by hospitals, according to outplacement firm Challenger, Gray and Christmas. So far this year, the health care sector has announced 41,085 layoffs, the third-most behind financial and industrial companies.

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Most "successful" hospitals belong to large, predatory healthcare systems. Their top management, CEOs, now make more than ever. Yet staff regular staff is cut and travel nurses fill in. Staff is held more accountable these days for infections, lack of care and medical errors. At the same time staff is more burned out than ever.

[FarCenter]

1. As demand is dwindling, blood banks make changes

Blood banks are declaring fewer critical shortages these days and in some cases cutting staff in response to dwindling demand for blood – the result of fewer elective surgeries being performed and medical advances that curb bleeding in the operating room.

...

Blood centers shifted “from a collect-as-much-as-you-can mentality to a collect-to-need mentality,” said Dr. Darrell Triulzi, medical director for the Institute for Transfusion Medicine in Pittsburgh. “They started collecting only what they needed. That’s new to the industry. We’re still learning how to do that well.”

Job cuts have been a part of the process.

The Indiana Blood Center announced in June that it would eliminate 45 positions in a restructuring that also involved reducing its mobile operations, closing a donor center and cutting other costs because demand from hospitals had fallen 24 percent from the previous year.

...

The blood-collection system began changing dramatically with the Great Recession, when Americans who had lost their jobs and health insurance put off noncritical procedures. Also contributing to the decline are blood-management programs, which include collecting blood lost during surgery and returning it to the patient, maximizing hemoglobin levels to prevent anemia and using medications to reduce bleeding during surgery.

http://www.concordmonitor.com/news/nation/world/8868926-95/as-demand-is-dwindling-blood-banks-make-changes

[dkf]

2. I thought hospitals gave care regardless of insurance.

Would we truly see more use or less use if people get care on an ongoing basis vs having to go to the emergency room?

Are there any estimates? Not that I think they would correctly predict behavior but maybe there is a logical reason?

[hue]

3. COBRA Laws and EMTALA (The Emergency Medical Treatment and Active Labor Act)

ensure that Patients must be stabilized or have their emergency medical needs taken care of before being transferred to another hospital. For profit hospitals are adopting policies that non emergency Pts. must pay a certain amt. up front before care is given. This discourages the poor from going to for profit hospitals.

Healthcare is definitely changing.

[SheilaT]

4. What is probably going to happen as the ACA actually takes effect

is that over time many fewer people will go to the ER, so hospitals will be cutting back ER staff. On the other hand, regular doctors, especially primary care physicians, will see a very large increase in patients. Plus, there may be more regular admissions as people who previously never got care will now get surgery or other hospital-based treatment.

Overall, there will be a shift of where a lot of care takes place.

I work in a hospital (information desk, part time) and we got a letter from our CEO a week or two ago regarding this. They've also cut staff and are requiring employees in most departments to take what they're calling flex time, mandatory time off although you can use your leave time if you have it. Lucky me, I'm never sick and my first two years took almost no vacation time, so I have plenty of leave time accrued.

[hue]

5. There is a significant increase in numbers of Nurse Practitioners staffing clinics.

Outpatient clinics and Same Day clinics have increased their procedures--which IMHO is a good thing. Better to recover at home if you can!