Bedford Ramblings
Steve Mills

Healthcare industry. How much is healthcare and how much is just business.

Posted Friday, January 5, 2018, at 6:20 PM
View 39 comments
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    I also heard that Tennova Doesn't include delivering Babies as their role in healthcare service, and only delivers babies if it is an emergency! I believe I heard there is no Maternity ward in the Tennova Hospital in Shelbyville.

    Any Moms and Dads know the true facts on this?

    -- Posted by sui on Sat, Jan 6, 2018, at 4:19 PM
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    BCMC stopped delivering babies around the time they moved out to the country. Well before they sold to Tennova. When pregnant people see their provider for the pregnancy they know where they will be going for the delivery. Not a good idea to try and make an ER deliver the baby when they don't have maternity services or OB providers on staff. Not good for baby or baby momma.

    As far as the healthcare industry being healthcare or a business, it is both. If they want to keep the lights on and the doors open, they have to make the money to pay the expenses. Even a "nonprofit" that doesn't make a "profit" will cease to exist. Unless you want the guberment to do it all. Then we wouldn't need to worry about how much it cost cause we wouldn't be well enough to get out and spend our money on anything else.

    -- Posted by fair share on Sat, Jan 6, 2018, at 9:09 PM
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    Is not Tennova owned by Community Health Systems?

    -- Posted by Grit on Sat, Jan 6, 2018, at 10:25 PM
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    But I hear Taxpayers everyday saying they are paying the expenses of the poor people who can't or won't pay their doctor and hospital bills!

    -- Posted by sui on Sun, Jan 7, 2018, at 1:07 AM
  • What about the tie between healthcare providers, insurance and pharmaceutical companies?

    Insurance requires redundant steps that do not seem to benefit the patient or even insurance. There are such big discounts thatbit may not cost the Insurance THAT much so what os the benefit?

    -- Posted by stevemills on Sun, Jan 7, 2018, at 6:45 AM
  • Having a friend that is an insurance agent, we had the discussion about the cost of insurance. I commented that insurance is so high because agents make exorbitant salaries and enjoy many other perks such as paid vacation trips all over the world.

    His reply was that they earn these salaries by keeping the insurance costs low for the buyers. Obviously, his idea of low costs and mine are different.

    Then, he went on to compare the price of insurance to automobiles. His point being that auto manufactures have highly paid executives who make more money by keeping the price of automobiles low and increasing the companies profits.

    I reminded him that automobiles are manufactured all over the world and sold locally in direct competition with one another. This is not the case with insurance. The laws do not allow insurance companies to cross even state lines much less international borders!

    To me healthcare and insurance has become a mafia run type business. The tactics of fear work to line the pockets of the thugs who are able to insert themselves between the patient and caregiver. It is the old "something terrible may happen to you if you don't pay us" mentality.

    The "terrible" thing goes beyond the actual health issue and reaches into financial ruin. Even a child birth, which used to cost very little, can destroy a families finances now. So, the exorbitant "protection" money is paid. The healthcare providers get there share of this through "in-network" services and thus the fleecing is carried out.

    Basically they have a literal death grip on people and their finances.

    Fortunately, there are some companies and associations that are beginning to provide direct care for direct payment. Hopefully, this will gain more ground in the market.

    -- Posted by Liveforlight on Sun, Jan 7, 2018, at 5:10 PM
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    When Obamacare is gone, the insurance companies will have to compete with each other. That should lower insurance policies, but I believe it will lower coverage as well.

    -- Posted by sui on Sun, Jan 7, 2018, at 5:24 PM
  • Liveforlight, hope you are still friends. 😳

    It has always felt like a business built in fear but theoricing is sooo exorbitant. A detailed is like a shipping quote. $1,000 to start, yhen discount, write offs and the bill comes to $75.

    Then you hav 2-3 bills coming in from just one visit. Keeping them straight is chalkenging at any age but senior citizens must be tied on knots

    -- Posted by stevemills on Sun, Jan 7, 2018, at 10:38 PM
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    The Emergency Medical Treatment & Labor Act (EMTALA) requires a hospital that takes Medicare to treat anyone regardless of the ability to pay.


    I suspect that Medicare and Medicaid provides over 60% of the revenue at the Tennova Healthcare Shelbyville hospital, with private insurance comprising the rest. I also suspect that the amount of unpaid bills is very high at our local hospital. This is not uncommon for rural hospitals nationwide.

    Community Health Systems of Franklin, TN owns Tennova. In 2015 Community Health Systems stock was trading over $52 per share, now it is a little over $4.

    Dianne Black, who represents Tennessee 6th district, proposed to eliminate EMTALA:


    If EMTALA is eliminated then a hospital can refuse to provide service to those who cannot pay.

    -- Posted by Grit on Mon, Jan 8, 2018, at 8:40 AM
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    Actually, EMTALA requires that they evaluate the patient for an EMC (emergency medical condition). If the hospital determines an EMC is not present, even tho the patient may be ill or injured, they are free to tell them to take a hike. If an EMC does exist, the facility is required to stabilize/treat the EMC within it's capabilities. Either way, rural hospitals won't refuse to treat patients based on their ability to pay. Too much bad PR. They will cut back on services provided. They have to keep the lights on and the doors open. Sounds like Rep Black doesn't want to let those who choose to go without insurance force the rest of us to be their slaves.

    -- Posted by fair share on Mon, Jan 8, 2018, at 9:52 AM
  • Maybe we should pass a law that requires Walmart and Kroger to "serve" people regardless of their ability to pay.

    What about McDonalds, Wendy's or Chilis?

    Car sales?

    Real Estate?

    Where does it end?

    -- Posted by quietmike on Mon, Jan 8, 2018, at 11:32 AM
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    Soooommmeee wwhheeerrreee, ooovveerr the rainbow.

    -- Posted by fair share on Mon, Jan 8, 2018, at 1:23 PM
  • Turned up my volume fair share and still could not hear it but I predictbthe lyrics will last formanlong time. 😆

    -- Posted by stevemills on Mon, Jan 8, 2018, at 1:52 PM
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    -- Posted by fair share on Mon, Jan 8, 2018, at 2:39 PM
  • Unfortunately you're likely correct Fair.

    Folks looking for freebies never see a limit.

    -- Posted by quietmike on Mon, Jan 8, 2018, at 4:05 PM
  • Steve, yes we are still friends. In fact, he and his company are still my insurance providers. They have the best deal.

    It boils down to economics. People trying to change the free market system think that socialized medicine is the solution. It isn't! No matter what, it boils down to paying the least to get the most. Or, the shortest path between two points. Inserting the government in between simply lengthens the path and increases the costs. However, people will STILL use free market principles, (the most service for the least cost).

    Those thinking the government is the solution citing "we are all in this together", are only looking for a way to bring down THEIR cost, not total costs. The government doesn't care about costs because they don't earn any money. They just take it from someone who does.

    The business end has become corrupted. Unless, the costs can be reduced to a reasonable level, there is little hope of seeing any real solutions.

    -- Posted by Liveforlight on Mon, Jan 8, 2018, at 5:03 PM
  • liveforlight; not to take sides, because different countries have different variations on how they approach health care, but we in the US pay twice as much for medical care as any other first world country. We don't get twice as much care. We get basically the same level of treatment, if not a little less. We just pay twice as much. It seems a little arrogant, and a lot foolish to tout the superiority of a system which performs measurably below the ones we are decrying.


    -- Posted by lazarus on Mon, Jan 8, 2018, at 9:50 PM
  • Reading what I just wrote, I guess I am taking sides. If paying the least to get the most is our objective you cannot fail more profoundly than to rate behind every one of your peers in that measurement (and not barely behind, twice as much for the same thing). I am not saying that the free market system is not superior. But, if it is superior, we are clearly operating in something less than a free market system.

    -- Posted by lazarus on Mon, Jan 8, 2018, at 9:59 PM
  • we are clearly operating in something less than a free market system.

    -- Posted by lazarus on Mon, Jan 8, 2018, at 9:59 PM

    I couldn't agree more! That is what I meant when I posted this;

    The business end has become corrupted. Unless, the costs can be reduced to a reasonable level, there is little hope of seeing any real solutions.

    -- Posted by Liveforlight on Mon, Jan 8, 2018, at 5:03 PM

    The free market/business SYSTEM has been corrupted. The free market PRINCIPLES (most for least) still apply and always will.

    -- Posted by Liveforlight on Tue, Jan 9, 2018, at 6:01 AM
  • A couple answers to some of the questions asked. Tennova is owned by CHS and has been for a little over 10 years, I think it was around 2005ish. The Tennova name is the TN brand name for all the CHS hospitals in Tennessee. CHS was responsible for building the new hospital as it was part of the agreement when the buyout occurred. It was built with a very nice maternity ward, but due to lack of OB's in Shelbyville the decision was made to stop delivering babies. We still have no OB's in county and only a part-time GYN that is shared with Tullahoma. The maternity unit was turned into the Pre-op|Same-day surgery unit and stays pretty busy most of the time. The ER has delivered a few babies unexpectedly, but after they (mom & baby) are stable, they head down the road to receive care.

    Tennova will take care of anybody regardless of the ability to pay or if they have insurance or not. They are still in the caregiving businesses after all.

    Our health care system is a big mess right now. We have regulations upon regulations that have to be followed, many of which are not needed, but because of multiple reason are put in place. I'm with some that say if we would let the free market work many healthcare cost would come down. Transparency in cost would help also. If you could pick where you had tests or procedures done based on cost and quality what would you do? Pick the most cost effective place, right? I know many are for a totally government run healthcare system, but in my experience all that has done is driven up the price of healthcare, but that's just my opinion.

    -- Posted by SharonSue65 on Tue, Jan 9, 2018, at 10:36 AM
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    Besides driving up costs (even more), it would also drive down quality (even more). Getting the government to run things (anything, everything) is just a liberal ploy to fundamentally alter the fabric of this great nation. And they've been doing a bang-up job of it for decades.

    -- Posted by fair share on Tue, Jan 9, 2018, at 12:31 PM
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    So it comes right back down to what I asked in the beginning - Is Tennova creating a Family of (dedicated to Tennova) Physicians for the purpose of Monopolizing the health care in Bedford county and Money flow to Tennova's bank account? It's like the Harvey Weinstein scandal, who knows, cares or will be able do anything about it!

    -- Posted by sui on Tue, Jan 9, 2018, at 10:03 PM
  • Another vote for getting government out of healthcare.

    Canadians are still coming to the US to avoid the long wait for care.


    In England, NHS ordered the cancellation of all routine surgeries due to bed shortages.


    -- Posted by quietmike on Wed, Jan 10, 2018, at 5:26 AM
  • -- Posted by RocketValentine on Thu, Jan 11, 2018, at 5:10 AM
  • Unfortunately, obamacare is still current law, and Baltimore has been run solely by democrats since the 1960s.

    -- Posted by quietmike on Thu, Jan 11, 2018, at 8:44 AM
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    Wrong again, Mikey.

    Maryland has a republican Governor and also the 1st district in Baltimore has a republican congressman.

    -- Posted by RocketValentine on Thu, Jan 11, 2018, at 9:18 AM
  • I don't know if I should say anything, or not, but Steve is having some issues with his health right now. He might not want the issue publicized, but I am sure he would not turn down any prayers or positive thoughts sent his way.

    -- Posted by lazarus on Thu, Jan 11, 2018, at 1:25 PM
  • Neither the governor nor a congressman has much say in the day to day running of a city.

    Look at the history of their city council and mayors.

    -- Posted by quietmike on Thu, Jan 11, 2018, at 1:27 PM
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    Mikey, you're statement was that the city of Baltimore is "solely run by democrats".

    If they have a Republican Governor and Congressman, that's just an erroneous statement.

    Now you can try to argue that a city councilman has more power than a Congressman or Governor (which I also disagree).

    But the Governor and Congressmen of that district have a lot to do with how a large city like Baltimore is run.

    So you're statement that it's "solely run by democrats ", would be false.

    -- Posted by RocketValentine on Thu, Jan 11, 2018, at 4:01 PM
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    Sorry to hear about Steve, laz.

    Hope he is on the mend and feeling better soon.

    -- Posted by RocketValentine on Thu, Jan 11, 2018, at 4:04 PM
  • Your prayers and good thoughts helped. I am out of Vanderbilt and it turned out relatively well.

    I have been having a tightness in my chest for more than a week. After 8 heart attacks I know symptoms but the persistence of this made me finally have it checked out.

    Short version, I was admiited to Vanderbilt even though they have been diverting patients for almost a week. My cardiologist found a way.

    There are some small veins that are probably causing the issue but nothing they can fix. The good news is that all the main arteries look good so I am back home.

    -- Posted by stevemills on Thu, Jan 11, 2018, at 4:33 PM
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    Glad you're back home, Steve. Be careful when it is cold out. No shoveling snow, especially if it is yellow.

    -- Posted by fair share on Thu, Jan 11, 2018, at 9:33 PM
  • RV,

    Once again, the governor or a congessman has no input on how a city is run. The day to day operations of a city are controlled by the city council and mayor.

    If you think this is incorrect, perhaps you can show some gubernatorial edicts passed down that only applied to Baltimore and not the entire state.

    -- Posted by quietmike on Thu, Jan 11, 2018, at 10:21 PM
  • Actually, QM, the day to day operations are controlled by the professional staff. Depending on the form of government in a city charter, the mayor might, or might not directly supervise department heads. In a city with a city manager, only the city manager directly supervises the department heads. But, to my knowledge every state prohibits council members from directly supervising employees. Due to the unfortunate fact that there are zero prerequisites to become an elected official, such laws are necessary to prevent an unqualified council member from stepping in to supervise firefighters at a fire, a swat team during a hostage situation, or public works employees using heavy equipment; and getting someone killed.... Don't laugh. The ones with the least business doing such a thing are the very ones that have to be told that they cannot!

    City Councils can only pass ordinances and establish policies. Implementation is the responsibility of the professional staff. You should be glad. If the council was supervising, nothing would get done. And the state can (and does) pass legislation that supersedes local government decisions. Think of the recent examples in Tennessee.

    -- Posted by lazarus on Fri, Jan 12, 2018, at 1:25 AM
  • Sure Laz,

    But do governors or congessmen run the operations of cities?

    Do mayors and the city council make the rules that govern day to day operations of a city or congessmen and governors?

    -- Posted by quietmike on Fri, Jan 12, 2018, at 8:48 AM
  • Thank goodness they don’t manage employees.

    Mayors and governors may not manage but they so influence.

    Two cents for the day.:-/

    -- Posted by stevemills on Fri, Jan 12, 2018, at 9:56 AM
  • "Do mayors and the city council make the rules that govern day to day operations of a city or cong(r)essmen and governors?"

    You won't like the answer, QM, but the day to day operations of cities are governed by state and federal regulations. Mayors and City Councils have almost no say in how day to day operations are run. New City Council members are often disappointed to discover the limitations of their power. In a typical small city (like Shelbyville) half a city manager's job is explaining to the council that what they want to do is not legal. In larger cities there is an assumption that people running for mayor will (just by good luck) have the background to enable them to function as CEO of an economic entity of that scope. However, the same regulations control the actions of those cities as well.

    The City Council does approve the annual Budget. However the structure of the budget, and many parameters are also regulated by the state and federal government.

    As much as it might feed a desire to attribute the financial status of large cities to their administration, it is largely due to overall economic situations beyond their control. The South is "benefiting" right now from the fact that it is much cheaper to destroy new "greenfield" land than it is to reclaim "brownfield" land that was previously "developed." We are creating tomorrow's Detroits today.

    -- Posted by lazarus on Fri, Jan 12, 2018, at 1:27 PM
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    I see by the Times Gazette that Tennova has it's hands in 5 Family Healthcare facilities in Bedford county. Hummm?

    -- Posted by sui on Wed, Jan 17, 2018, at 11:27 PM
  • Sui, is that of any greater concern than the big 3 hospitals in Nashville owning practices and having offices scattered throughout middle TN, including one in Shelbyville?

    -- Posted by SharonSue65 on Thu, Jan 18, 2018, at 4:30 PM
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