The Virginian-Pilot
©
NORFOLK
Children's Hospital of The King's Daughters laid off 28 employees Friday, one move in a series of cost-cutting measures the facility is taking to shore up finances.
The hospital also announced that 90 positions frozen last year will not be filled. That follows the hospital's announcement in December that it will close its on-campus child-care center, which employs 27 people, by June 12.
Jim Dahling, CHKD's president and chief executive officer, said it's the biggest reduction in staff in about a decade. The hospital - which employs 3,000 - had been in a growth mode for the past several years, expanding its reach throughout the area with satellite offices and new services.
However, Dahling said patient volumes were less than expected during the last half of 2008. Also, the hospital has been losing money on Medicaid patients, which constitute 55 percent of the hospital's inpatient revenue.
Hospital officials also are looking ahead to proposed state budget cuts to the Medicaid program, which could cut their revenue by millions. Gov. Timothy M. Kaine is proposing cuts to Medicaid, which is a joint federal-state program for low-income people and people with disabilities, to help make up for a state budget shortfall.
A state cut in Medicaid would trigger a loss in matching federal money as well.
Dahling said he didn't know why patient volume was down but that the economy could be forcing families to for go elective surgeries.
"We also do a good job preventing kids from getting ill," he said.
The job cuts were in administrative, support and management areas.
Hospitals throughout the area are tightening their belts as a result of an increasing number of patients who are uninsured or insured by Medicaid, which reimburses hospitals for less than the cost of care.
Virginia hospitals estimate they receive about 75 cents in Medicaid for every dollar they spend on the patient. Proposed budget cuts could reduce that to 70 cents. If a cigarette tax that Kaine is proposing does not go through, losses would be even higher.
Children's hospitals throughout the country typically have a higher mix of Medicaid patients than other hospitals because of the large number of children covered by government insurance.
Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com
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Tricare doesn't pay that well
CHKD does accept Tricare, but Tricare's reimbursement is equal to that of Medicare, which only reimburses a few dollars (in some cases, cents) more that Medicaid. Any insurance that is funded by the government, ie Medicare, Tricare, Medicaid, Champva, etc, their reimbursements are far less than that of a commercial carrier. In fact, they ARE the absolute lowest, so taking more Tricare patients, wouldn't help that much. Unfortunately, the kids need medical care, but their insurance isn't covering the cost of the treatment, which results in ugly, ugly write offs.
Tricare
Does CHKD still not take Tricare? That could be part of the problem right there. At least Tricare reimburses more than Medicaid.
Clearing Up Some Billing Misconceptions
Any health system which does business with Centers for Medicaid and Medicare Services would be in violation if they billed patients differently based on their insurance carrier. Every patient gets charged the same amount. Differences occur when the health system is reimbursed. Virginia Medicaid often reimburses between .27 and .33/dollar. For CHKD, one of the issues is the number of children who present to the ER with non-emergent issues. If a parent brings a child to the ER with the sniffles, edicaid will only pay a minimal triage fee to the hospital. If the parent took the child to a pediatrician's office, that child would have a better continuity of care; were there a pattern of illness, it would be caught more quickly; the wait times in ER's would go down precipitously; and reimbursement would be more appropriate to the level of service rendered.
Ed is wrong
Sorry, Ed, you are wrong. Your examples may be correct, but not for the reasons you state. There is a cost of doing business to provide health care. That cost is what the govt is short paying with .75 on the dollar. If someone doesn't have insurance, they can work out a discounted price and payment plan. That discounted price is made up through charity care the hospital offers. How do hospitals and other care providers make up for the medicaid shortfall? They have some services that make money. It's a careful balancing act. Want to see what I'm talking about? Go to the nursing homes. Do you know why many of them don't look all that great or why the care doesn't seem to be that good? Most of them have a large portion of patients on medicaid. They can't do much if they don't have the money to pay for it.
CHKD Staff Cuts
In these hard times when budget cut are going to have to be made I know the choices are hard for both Gov. Kaine and they will be for our own Mayor Fraim and City Council Members. Every time we have a crisis that requires money be cut from the budget first thing they do is cut from education, healthcare, police & fire protection, transportation and infrastructure. I believe these are the LAST places they should be cutting, especially since they have already been cut to death. This time they need to start at the top with salary and benefits freezes for anyone making $100,000.00, say five (5) years, and a 5% pay cut over $100,000.00 for the next two (2) years just to help thing out. Then lets reduce some of the Executives. We are a little top heavy is some of the education departments for example and I sure that's not the only one. The police department has a lot of dead weight in it we could get rid of that would free up money to spend where it is really needed in that area. Then we have projects both state, and city that could wait until we are in a better financial position it start.
Now is the time to tighten our belts, but don't sacrifice our children. Make sure we ti
Kaines cuts...
Here is how it works, a person paying cash walks in to get a procedure, the price is $2,000. Another person walks in with Medicare or Medicaid, the price for the same procedure jumps to $6,000. The gov says they will not pay that and will only pay $4,000. The hospital/doctor says "okay" and charges the gov $4,000 and takes a writeoff of $2,000 as a loss on taxes. You can cut either program and the whole scam will still work, and they might only make $3,000 on a $2,000 procedure and take a $3,000 writeoff. Handling the billing for two elderly people, I see this all the time. I am not saying that this is what CHKD is doing, but this is probably the reason why Kaine is okay with the cuts.
re: Budget cuts
ProgressiveMom wrote:
>>>I am really beginning to get concerned about some of Gov. Kaine's budget cuts. I have been in agreement with much of what he has done in office<<<
JUST getting concerned?! And what, pray-tell, has Kaine done in office to illicit your agreement? By the way, campaigning for Obama and becoming DNC chair doesn't count; leaves his accomplishment list pretty short (if non-existent...).
Budget cuts
I am really beginning to get concerned about some of Gov. Kaine's budget cuts. I have been in agreement with much of what he has done in office, but this is the second story I've seen about cuts that are damaging programs/services that seem critical. These cuts to Medicaid are obviously affecting the finances of places like CHKD, and those types of ramifications need to be considered. I personally think things like healthcare should take precedence over things such as improvements to infrastructure which has seemed to be a priority for the governor.