Profitable nonprofit hospitals

Seven of the 10 most profitable hospitals in America are nonprofit. Mayo Clinic, Cleveland Clinic, and Johns Hopkins fall into this category. Having a non-profit designation means the hospital is exempt from federal and local taxes. In exchange, the hospital must provide a certain amount of “community benefit.” Ideally that benefit should be charity medical care. Instead, the hospitals can qualify for the tax exemption by accepting Medicaid insurance, which, it turns out, allows them to make even greater profit.

Here’s how it works: hospitals calculate the gap between Medicaid payments and the hospital’s self-determined costs for procedures. That gap constitutes their “community benefit.” Thus, the Affordable Care Act has been a real financial boon to them. It brought millions more paying customers into the field, such that the revenue in the top seven nonprofit hospitals increased by 15 percent, while charity care—the most tangible aspect of community benefit—decreased by 35 percent.

With charitable care being optional, it stands to reason that nonprofit hospitals are often the most profitable: they don’t have to pay taxes. They also benefit from tax-free contributions from donors and tax-free bonds for capital projects. Plus they’re allowed to include training residents, fellows, and other clinical staff as community benefit. The most profitable nonprofit hospitals tend to be part of huge health care systems. Monopoly hospitals are known to charge more than non-monopoly hospitals.

The average chief executive’s package at nonprofit hospitals is worth $3.5 million annually. From 2005 to 2015 the average chief executive compensation in nonprofit hospitals increased by 93 percent. Nurses got 3 percent.

OK: While I’m at it, I’ll throw in a couple more factoids about health care: patient care generated $3.6 trillion in 2018, an amount shared by your hospital, doctor, and insurer. Also, according to the Bureau of Labor Statistics, the poorest people in this country spend 35% of their pre-tax incomes on health care and the wealthiest spend 3.5% of their income on health care, but the wealthiest spend an average of $8,720, compared to $2,119 for the poorest people. No surprise there.

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Maybe you’re not losing it!

This morning I couldn’t think of the word, “ultrasound.” These lapses seem to occur daily. Neuroscientist Daniel J. Levitin maintains that such lapses are not necessarily age-related (I’m 83 as I write this). He says that short-term memory contains the contents of our thoughts right now and is easily disturbed or disrupted by new thoughts or distractions. (For me, sometimes it's panic about my ability to remember the word or name.)

He does concede that our ability to automatically restore the contents of our short-term memory declines slightly with every decade after 30. But he says that age is not the major factor in such memory problems. As a professor, he finds that 20-year-olds make “loads” of short-term memory errors—similar to those of 70-year-olds. The difference is that we old people worry about our lapses. “In the absence of brain disease,” he says, “even the oldest older adults show little or no cognitive or memory decline beyond age 85 and 90, as shown in a 2018 study.”

In fact, according to Levitin, some aspects of our memory actually get better as we age, including our ability to extract patterns and to make accurate predictions. Such improvements are the result of our years of experience. You’re better off having a 70-year-old radiologist reading your X-ray than a more youthful one.

He says we fumble with words and names because of a “generalized cognitive slowing” with age, but that given more time we do just fine. What’s more, we have more information to search through as we struggle to recall something—a condition called “crowdedness.” OK. I like that. My brain is simply too crowded with information to recall words quickly. No worries!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Surprise medical bills

Some friends of ours had to sell their beautiful home because of a surprise medical bill. The husband had a heart attack while kayaking and was taken by ambulance to the nearest hospital. But the hospital turned out to be “out of network”: it had no contract with my friends’ insurer. I don’t know what my friends paid for the medical care, but I read about a patient who was charged $500,000 for ten weeks of dialysis treatment in an out-of-network facility. Maybe that person lost his or her home also.

In negotiating contracts, hospitals select insurers that give them the best rates and have the best reimbursement history. But physicians at the hospital may not be in the network. Sometimes they choose not to participate in any networks at all. They can charge whatever they want, but you might not know this. You might choose a hospital and surgeon who are in your insurer’s network but discover too late that the participating anesthesiologist and radiologist are not.

A new study showed that surprise bills can be anywhere from 118 percent to 1,382 percent higher than what Medicare is billed for the same services. In 2017, about one in six Americans were surprised by a medical bill after treatment in a hospital—despite having insurance. On average, 16% of inpatient stays and 18% of emergency visits leave patients patient with at least one out-of-network charge. Most of those came from out-of-network doctors offering treatment at the hospital, even when the patients chose an in-network hospital. Insurance companies agree to pay a portion of the non-participating doctors’ bills. The patient pays the rest. Surprise!

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

An alternative to opioid painkillers

My husband came home from a six-hour dental ordeal with a printout of a pain management regimen. It was devised by a couple of surgeons as an alternative to opioids. Apparently, the docs have been able to reduce their opioid prescriptions by about 75 percent. The regimen is for managing acute pain—as with post-surgery pain or other injury. It's simple:

• Tylenol: two pills, 500 mg each
  Wait 1-2 hours.

• Advil or Motrin: one pill 800 mg (or four 200 mg. pills)
  Wait 6-8 hours from last Tylenol.

Repeat, starting with Tylenol again. For acute pain, do this three times a day for up to five days. My husband did it once (Tylenol and later Advil) and said it helped. The doctors advise taking the pills with food and drinking plenty of fluids.

Note: In the interests of science, I tried one round of the Tylenol followed by Advil for my ordinary aches and pains. I wasn’t particularly impressed. Then I discovered, weeks later, that I should have taken four Advils, not having noticed the number of milligrams specified. (My husband did the same thing I did.) Note also that taking too many anti-inflammatories (Advil) suppresses your immune system, so don’t overdo.

Here’s a fun thing I stumbled on while doing some research: Tylenol (acetaminophen) reduces feelings of anxiety and social rejection! It does this because the part of the brain Tylenol affects--the part that senses physical pain--is the same part that senses social pain. A twofer!  

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Side effects of blood pressure meds

My sister, who is 85, complained of being tired. Then she got a painful case of gout in her foot. She stopped taking her blood pressure medication, a diuretic called hydrochlorothiazide. Her tiredness went away as did her gout. Then she got a kidney stone, which, with the help of drugs, she passed. Of course, I started researching the side effects of blood pressure medicines. Here’s what I found:

• Tiredness: Blood pressure medicines lower the pressure inside blood vessels, so the heart doesn’t have to work as hard to pump blood throughout the body. The meds cause fatigue because they slow down the pumping action of the heart and depress the entire central nervous system. Because diuretic BP meds make you pee a lot, you deplete important electrolytes, which causes fatigue. 
• Gout: Your body produces uric acid when it breaks down purines — substances that are found naturally in your body. Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. If your kidneys excrete too little uric acid, the acid can build up, and form sharp, needle-like urate crystals in a joint or surrounding tissue. The result is pain, inflammation and swelling. Because the diuretic type of BP meds increase urination, the amount of fluid in your body is reduced and the remaining fluid is more concentrated, which increases the risk of developing the crystals that cause gout. (My sister’s doc discounted the gout idea and said it must have been an insect bite. Give me a break.)
• Kidney stones: As I mentioned above, the diuretic type of BP meds increase urination. Because of the increased loss of water, the calcium in urine becomes more concentrated, which can lead to the formation of calcium stones. My sister’s kidney stones may not have been caused by her meds, but for some people BP meds are definitely implicated in the formation of stones.

Incidentally, another important side effect of blood pressure meds is dizziness or light-headedness, which I’ve mentioned in an earlier post. My sister didn’t get dizzy. But dizziness from these drugs is a major cause of falls in old people.

In the interest of science, I took my blood pressure. Initially, when I was in a bit of a huff about using the device, my BP was 150 over 80-something. I then sat and did deep breathing from my diaphragm, as taught in yoga. My BP dropped to 124. A do-it-yourself remedy.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.