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Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

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Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#121

Post by bumby »

arcbyte wrote: post #107
bumby wrote: post #99

Earlier quoted context omitted.

Are you saying medicare/medicaide are net-negative? Is so, what prevents hospitals from refusing to accept them? I suspect they don't because it's not financially solvent to do so, given the number of patients who use those services. That on it's face seems to bring into question the claim that they are net-negative (whether that's due to legislation or other means).

Hospitals are required by EMTALA[1] to treat all emergencu patients to the point of stabilization. So it only makes sense to charge whatever insurance is available because there is no turning them away. Im not sure if there are regulations applicable to hospitals that prevent them from refusing to accept medicaid patients for elective procedures. Certaibly there are lots of surgery centers that do refuse medicaid. Al…

You're right with regard to emergency treatment; so in the case of the withdrawal patient that holds. But hospitals are not required to accept any insurance, including medicare/aide (they are termed "non-participating"). So I don't think the premise holds in the knee-replacement scenario.

So, to be generous, maybe there's a case that if a hospital gets a bulk of its revenue from the ER, it's a better business case to accept Medicare. But I don't believe that's the case for most hospitals, so it still leads me to question the premise that medicare is a net negative (or else we'd see a lot more 'non-participating' hospitals).

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#122

Post by edmundsauto »

gniv wrote: post #100
harimau777 wrote: post #55

Earlier quoted context omitted.

Disclaimer at the start: I'm asking this because I want to understand more about the situation that you are presenting, not as an indirect way to "um actually" you. How would margins be defining in this case? When I hear that the margins at gas at a gas station are x%, I understand that they are basically talking about how much I pay per gallon minus how much the gas station paid per gallon. However, it feels like de…

I think you are right to be suspicious. For example, back when I lived in the US and went for a checkup at a big hospital in NY: first there were greeters at the entrance of the building, then a greeter on the right floor, then a small army of receptionists, then a nurse, then a PA, then the doctor. All these are expenses. Are they necessary? Here in France there is, maybe, a receptionist that sends me to the office…

I believe it is common for the greeters to be vounteers

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#123

Post by bumby »

gniv wrote: post #109
bumby wrote: post #99

Earlier quoted context omitted.

Are you saying medicare/medicaide are net-negative? Is so, what prevents hospitals from refusing to accept them? I suspect they don't because it's not financially solvent to do so, given the number of patients who use those services. That on it's face seems to bring into question the claim that they are net-negative (whether that's due to legislation or other means).

At least on paper they are net-negative. If you look at a Schedule H of IRS Form 990 they report huge shortfalls from Medicare/Medicaid. This I think helps them claim "community benefit expense". Example Form 990 (search inside for Schedule H): https://my.clevelandclinic.org/-/scassets/files/org/about/fi... See also page 8 of this pdf: https://www.aha.org/system/files/media/file/2023/10/Results-...

Thanks for sharing that. Do you happen to know how they calculate the "community benefit expense" that creates the shortfall?

My understanding is that medical billing is inflated so they can anchor a high value to help in their negotiations with medical insurance. I'm wondering if this is the medicare adjusted value (i.e., what medicare says the procedures are worth) or the artificially inflated value?

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#124

Post by prerok »

BariumBlue wrote: post #64
csharpminor wrote: post #59

CEO salaries should be understood in relationship to the resources that they control. For example, this CEO chose to spend $85M on travel nurses to counter the union strike happening at a hospital in their network. Presumably the CEO thinks that this gamble is worth it in forcing the union’s hand. That may be a terrible decision, but it shows the extent of resources a CEO of a $6bn organization commands. This is one…

Wasn't there analysis that company performance is inversely correlated to CEO compensation? I remember seeing a chart, though I don't remember whether the analysis was well done & researched or not

I have not seen it but, to me, it kind of makes sense if you put an average overall.

I think companies making a lot of money are in a world of trouble: sweet trouble, to be sure, but still trouble.

Sustaining the same percentage growth is incredibly difficult once you are big. So, what is there to do? Expand to new markets, create new products with the potential to destroy your existing ones, fire people you think are no longer needed? Decisions that will either make more money or destroy the company. And, no matter what anyone else would say, I think their decisions are worse than half chance.

In the end we praise the CEOs that made the "right" choice. But it was the right choice only in hindsight, it could easily have gone in the other direction, as many many examples of previously successful CEOs have shown.

Nobody stays on top forever and that's just how it is.

Now, as for the CEOs' salaries: they are the same regardless of their successful choices. So, when you average it out, it would look like it is inversely proportional, simply because more companies tank than stay on top.

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#125

Post by someguydave »

jonathan-adly wrote: post #68
harimau777 wrote: post #55

Earlier quoted context omitted.

Disclaimer at the start: I'm asking this because I want to understand more about the situation that you are presenting, not as an indirect way to "um actually" you. How would margins be defining in this case? When I hear that the margins at gas at a gas station are x%, I understand that they are basically talking about how much I pay per gallon minus how much the gas station paid per gallon. However, it feels like de…

Here are 2 relevant scenarios. A homeless alcoholic withdraws and gets seizures, spending a week in the ICU. He is not on Medicaid, but qualifies. After paying for all his care and applying for Medicaid on his behalf. The hospital might get 50 cents back for every dollar they spent. (They spent on doctors; nurses, medications; EMR bill, case management, etc.). This guy will essentially come back 5-6 times per year. W…

So you are suggesting that costs are primarily set by how much the government is willing to pay, and are completely independent of medical production?

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#126

Post by laboratorymice »

csharpminor wrote: post #59

CEO salaries should be understood in relationship to the resources that they control. For example, this CEO chose to spend $85M on travel nurses to counter the union strike happening at a hospital in their network. Presumably the CEO thinks that this gamble is worth it in forcing the union’s hand. That may be a terrible decision, but it shows the extent of resources a CEO of a $6bn organization commands. This is one…

The argument that this is simply the market rate required to attract a person with the required skills can be proven false in so many ways, for example:

1. It's not a market, there is no job advertisement for the CEO role that the general population can apply for. If there were, and if it were to offer a fraction of "market", there would still be thousands of applications, and the top 1% of those candidates would absolutely do the job as well or better than the typical hand-picked candidate.

2. There are several roles in society that place enormous responsibility on those professionals and that only a handful of people in the world can do well, yet those jobs still pay low 6figures max. For example, nuclear engineer, aerospace engineer, state leader, and yes, ironically, most public hospital directors.

The sad reality is that executive pay is simply a result of incentives and the fact that corporate hierarchy gets very thin at the top. It has no relation to the competence or direct value-added of the executive.

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#127

Post by conradev »

vkou wrote: post #106
conradev wrote: post #93

Earlier quoted context omitted.

I think it is a misunderstanding that the job market is optimizing for fairness: it is not. Executive pay is supply and demand. The mayor is being paid $450k because a person with the necessary skills was willing to take that salary (after fighting off opponents) to become mayor. Mayor comes with prestige, so more people want to be mayor, and $450k is not a terrible incentive to go after. If the government paid $80k…

If executive pay is supply and demand, and has risen stratospherically over the past 40 years, why has the supply of executives failed to meet demand for them? Are we not sending enough people to MBA school? Is there a funnel problem in our educational system? Do we need to open up more opportunities for skilled immigrants to work here in executive roles?

The US has terrible cost disease in a lot of industries, and I would lump executive compensation in with those industries.

I don’t think I’ve seen a good coherent theory for this specifically

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#128

Post by carlosjobim »

giardini wrote: post #34
adolph wrote: post #11

Do people believe that "nonprofit" is a category related to benevolence? It's just an accounting and corporate structure difference.

Yes. And we should eliminate nonprofits entirely: 1. Churches, hospitals et al should all pay taxes just as do other corporations. They are built on the same social structure as other entities, have the same protection of government and benefit from the social system. I pay; so should they. 2. Campaign Finance Reform: Secondly, laws should be changed so that corporations are no longer "persons". That is Citizens_Unit…

> I pay; so should they.

They don't pay and neither should you.

Why is it that when people are oppressed, their biggest desire is never to be free, but to see others suffer the same as them?

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#129

Post by csharpminor »

denton-scratch wrote: post #112
csharpminor wrote: post #59

CEO salaries should be understood in relationship to the resources that they control. For example, this CEO chose to spend $85M on travel nurses to counter the union strike happening at a hospital in their network. Presumably the CEO thinks that this gamble is worth it in forcing the union’s hand. That may be a terrible decision, but it shows the extent of resources a CEO of a $6bn organization commands. This is one…

> settling for a second-best CEO to save a 7-figure sum just doesn’t make sense. Really? You expect the CEO to make all significant decisions, all on his own? No wonder you think the CEO of a billion-dollar company needs a 7-digit salary. I think the main job of CEO is to appoint useful directors, and promote competent managers. That's certainly a challenging job; but it's a job you can learn, like any management job…

I’m engaging in good faith, no need for ad-homonyms.

No, I do not expect a CEO to make those decisions on their own. They also usually bring a team (or make choices about who to keep/remove). So even if they’re not deciding directly, they’re only a step or two removed. Many of the multi-million dollar bets being placed might just be on who to hire to make a decision and execute.

Incidentally, those key hires are often why CEOs command such a price. Their price simply reflects that power in human networks is highly consolidated. CEOs absolutely leverage their position as gatekeepers here.

All this to say why I don’t think we’ll be successful in curbing CEO pay, and should instead just focus on taxation.

Re: Nonprofit hospitals skimp on charity while CEOs reap millions, report finds

#130

Post by carlosjobim »

bombcar wrote: post #40
jackfoxy wrote: post #29

Think of nonprofit not as another term for benevolent or charitable organization (which is what people instinctively think), but as an alternative tax accounting scheme. Excess revenue gets funneled to the insiders at the top so that at tax year end there is no profit . Presumably these insiders are paying income tax. I once knew a guy who worked in the field of providing services to non-profits, and he described to…

It's quite likely that if you have two organizations - one setup as a for-profit company, one setup as a non-profit, that the government gets more taxes from the non-profit because the for-profit company can "reinvest profits" into whatever, driving the share prices up, which is (if done right) is a non-taxable event for everyone, as long as the shareholders don't sell. Whereas the non-profit that funnels excess into…

Can non-profits not reinvest income just as any other business?
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