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Willygolightly t1_j19n9fx wrote

Reply to comment by SolitaryMarmot in ‘Major Trustee, Please Prioritize’: How NYU’s E.R. Favors the Rich by goodguyfdny

These things are not the same.

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SolitaryMarmot t1_j19o049 wrote

17% of NYU Langone's patients are on Medicaid. 81% of Bellevue's patients are on Medicaid. They are literally right next door to each other. They are very much the same thing.

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Willygolightly t1_j19ooq1 wrote

Bellvue is the only mental health hospital in the city, and receives patients from many situations.

It is also what is called a “safety net” hospital, and is intended by the city to be a hospital that takes in people regardless of ability to pay or insurance status.

Among other things, NYU is a research hospital, working to advance new medical practices.

You aren’t totally without a point but this is a bad example.

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SolitaryMarmot t1_j1a1gwu wrote

So what you are saying is...some hospitals are for poor people and some hospitals are for people with money and good insurance.

And Bellevue isn't a mental health hospital. Its an acute care general hospital with psych beds, same as any other hospital in the city.

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DressOwn9783 t1_j1b7b6g wrote

appreciate you fighting the good fight here. crazy how some people will literally sit down and write out paragraphs about why a segregated healthcare system is fine and dandy

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Willygolightly t1_j1d7aje wrote

I never said our broken healthcare system was fine and dandy- just that the fact that if some wealthy individuals have given their money to make some facilities better it isn’t the fault of those individuals and their contributions that the rest of the system is broken.

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Willygolightly t1_j1c8cle wrote

No, what I’m saying is that Bellevue receives almost all of its funding from the NY State gov, and NYU receives most of its funding from outside sources.

Bellevue is also significantly larger in terms of capacity, and more has a larger ER and in patient facility.

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SolitaryMarmot t1_j1dk1nh wrote

That's not how hospitals work. All hospitals...including the publics run on net patient service revenue. They send the bill for services off to Medicaid, Medicare or private insurance and get reimbursement. All the hospitals that treat mostly Medicaid patients, including the privates, get some type of "extra" funding but usually not a lot. It's usually through the Disproportionate Share program and the Indigent Care Pool. In the years we have a mayor that chooses to support NYC Health and Hospitals (which so far has been deBlasio) - there is also a city subsidy. A lot of that is for outpatient services which runs at massive losses because its servicing the undocumented population of NYC as well.

But no outside funding stabilizes losses which are structural and built into the payer mix. Hospitals that don't have enough private insurance patients run at a loss. And while they aren't supposed to turn away Medicaid patients - they obviously do. NYU and Bellevue are literally right next to each other. NYU has 15% Medicaid and Bellevue has 81% Medicaid. All things being equal.. Why wouldn't Medicaid patients choose the "better" hospital if they actually could?

That isn't because of some freak of statistics. It's because NYU gives privileges to doctors who keep very few Medicaid patient appointments a month and have a long waiting list for new Medicaid patients. And when Medicaid patients come through the ED they tell them the wait is shorter at Bellevue or they don't have the right kind of physician for them on, or they don't have beds in case of an admit...in the case of psych patients they literally wheel them over to the Bellevue ED even though NYU does have psych beds (Bellevue is larger because it has more psych beds but otherwise they are both in the 800-900 bed range.) Bellevue would never say or do these things because it's contrary to their mission.

Your socioeconomic class...including the type of insurance you have, determines the quality of health care you get in NYC and around the country. But NYC happens to be particularly stratified. If you ever need to use Medicaid (or even Medicare to a lesser degree) be prepared to only be allowed to use the shitty hospitals and providers.

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ctindel t1_j1dts0y wrote

> Your socioeconomic class...including the type of insurance you have, determines the quality of health care you get in NYC and around the country.

This happens even in western europe, where everyone has coverage but people with more money can pay for upgraded service or to skip the queue. I don't know any country where a billionaire or whatever their equivalent of a senator is differently in the hospital.

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Grass8989 t1_j19pccq wrote

Hospital ERs aren’t allowed to turn patients away for any reason, including insurance type and ability to pay.

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SolitaryMarmot t1_j19rv4g wrote

LOLOLOLOLOL does everyone get lolipops and a puppy at discharge too?

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Grass8989 t1_j19smk6 wrote

It’s literally law, you cannot turned away from an ER for any reason. You should look into EMTALA. You’ve also clearly never worked in healthcare.

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SolitaryMarmot t1_j1a28gv wrote

Go to the NYS Sparcs data and see how many EMTALA discharges there are in total, particularly outside of L&D. A couple dozen maybe? EMTALA requres stabilization not treatment. If you are on Medicaid and/or uninsured (or of a demographic where you are more likely to me on Medicaid/or uninsured) NYU just has to determine you are stable enough to be wheeled down to the next set of double ED doors and they bring you right into Bellevue and say "this nurse will help you."

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ripstep1 t1_j1d45em wrote

You are so fucking incorrect it’s funny. Hospitals are mandated to admit if you meet admission criteria. They are mandated to find safe discharges. They are mandated to do so regardless of your pay.

We have patients that sit in beds for YEARS and pay NOTHING because they cannot afford a SNF bed.

Why talk about a profession you know nothing about

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SolitaryMarmot t1_j1dli4z wrote

They can't find a SNF willing to take a Medicaid patient so they end up sitting in the hospital (years no...a couple months is normal, seriously LOS data is public information. ) Hospitals do the exact same thing. They find ways to prioritize non Medicaid patients, particularly private insurance patients the same way SNFs do. They aren't supposed to turn away Medicaid patients because they are on Medicaid but the massive disparities in payer mix mean that they find a way to do it. This is literally the system that has been created and allowed to perpetuate. The SNFs are doing the exact same thing the hospitals are doing and vice versa because they are rational actors.

And Payment Topology is also public information. You can look at the public all payer dataset on line. EMTALA isn't treatment, it's just stabilization. And outside women in labor, it's pretty rare. It's actually pretty rare for women in labor too. Because NY actually has a very low uninsured population. Our Medicaid program is pretty expansive here. But it only gets you access to 3rd class or maybe 2nd class treatment.

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ripstep1 t1_j1drp0z wrote

You act like this a conspiracy unique to NYU. Every hospital does everything possible to optimize their payer mix. Rural hospitals are failing left and right because their patients are shitty Medicaid payers. Then dems laugh because they didn’t graciously accept the Medicaid expansion.

We literally have a patient sitting in our ICU bed who has been here for 10 years. Not an exaggeration. Routinely common for SNF placement patients to sit here for months.

These patients are exploiting hospitals for millions and the government sits idly by since it’s the hospitals problem, not theirs. NYU has plenty of these patients.

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ripstep1 t1_j1d3y0n wrote

Comparing bellevues mission to NYU LMAO

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SolitaryMarmot t1_j1dlry2 wrote

They are both acute care hospitals. NYUs mission is to treat rich people who can pay. Bellevue mission is to treat anyone who is sick. It shocks me that people are ok with that.

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30roadwarrior t1_j1d9m7k wrote

Add homeless mentally ill clientele using the hospital as a short stay hotel for a nice bed a free food and query how much of the 81% comes from that. Trying to frame it differently is disingenuous.

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SolitaryMarmot t1_j1dk65v wrote

Huh? Doctors still admit people or don't. They aren't going to admit someone that can be treated on an outpatient basis for no reason.

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30roadwarrior t1_j1isirb wrote

But making that determination can take 2 shifts of a stinky guy taking up and wasting a bed.

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