Men's Breakfast, March 14, 2015

The Men’s Breakfast Group met Saturday, March 14th with Al Guevara, CEO of the Brazosport Regional Health System.  Al was raised in Corpus Christi by a Lutheran Family in a largely Catholic City.  After high school he got trained as a respiratory technician and went to work for a Local Hospital.  He subsequently went to college and eventually got a master’s degree in Health Administration.  He worked as an administrator in East Texas hospitals before coming to Brazosport where he rose to chief executive of Brazosport Regional Health System. 
Brazosport Regional Health System is primarily the hospital plus auxiliary facilities such as the urgent care system facility.  They also manage some doctors’ practices.  Previously, the health system would recruit doctors and help set them up as individual practices and self-contained businesses.  The increase of paperwork in dealing with insurance companies has made self-employment less attractive, so doctors now prefer to work at clinics for a salary. 
The hospital is undergoing major renovations.  All semiprivate rooms are being upgraded to private rooms.  The hospital is also building a new emergency room at a cost of several million dollars. 
The hospital has a budget of over forty million dollars per year, most of which is salaries.  Its income comes from Insurance, Medicare, Medicaid, and self-pay patients.  About ten percent of the costs have to be written off because the patient does not have any money or the debt cannot be collected.  The hospital about breaks even on Medicare and has to make up for its free care by higher reimbursements from private insurance companies.  The Affordable Health Care Act has caused problems for hospitals in Texas.  The act assumed that many more people would be covered by Medicaid who would normally be non-payers.  Therefore the government reduced its payments to Medicare to make up the difference.  However, Texas did not expand Medicaid but the reductions to Medicare are still in effect so the hospital is losing money as a result. 
Another drain on funds is the for-profit free-standing emergency room across the street.  A facility can call itself an emergency room if it has a doctor present at all times and certain diagnostic equipment.  If it qualifies, it can charge insurance companies high emergency room charges but not have the overhead of a real emergency room.  Legally they have to take any patients that come in and stabilize them.  However, they usually refuse to take any patients that do not have private insurance and send them across the street to the Hospital if they can’t pay.  The free-standing emergency room can break even on about six patients per day.  This represents a loss of about $600,000 per year in revenue for the Brazosport Health System.  This is especially damaging because the staff of the hospital emergency room cannot be reduced because the same staffing and skills are needed regardless of the number of patients. 
There was discussion of funding of medical care in the U.S. compared to the rest of the world.  The U.S. spends about nineteen percent of its GNP on health care.  This is about twice that of other industrialized nations.  The health results are about the same as Ecuador, a developing country.  This is partly due to our nonsystem of payment.  The United States has every system of payment used around the world.  We have self-pay for people without insurance, primarily the poor.  This compares to third world countries where modern medicine is a luxury for the rich.  We have Insurance companies.  The Netherlands also uses insurance companies but these are highly regulated and mostly nonprofit.  We also have a socialized medical system like England in Medicare but only for those over sixty-five.  This is one reason that doctors often have three or four office employees for one doctor.  Al said that that the medical costs are still increasing ad may become unsustainable. 
The men had an interesting discussion and a good breakfast.  The next meeting will be April 11th.