数十家加州医院面临关闭风险，行业领袖在呼吁援助。 许多医院至今其实尚未从大流行的损失中得到足够弥补，而Medi-Cal和Medicare的报销情况基本停滞不前，而现在服务成本一直飙升。 Carmela表示，真正的危机和担忧是，如此高比例的关闭危机对整个加州的每个社区都有影响，「这些社区的医疗保健正在受到侵蚀，因为我们正在失去某些服务，医院试图维持生计，无论是关闭产科护理、行为健康服务还是其他，都是社区民众的损失。」 「MLK Community Healthcare」首席执行官Elaine Batchlor说，她的小医院服务于洛杉矶南部的部分社区，长期以来一直是洛县最繁忙的急诊室之一，她说，按照医患比例标准，社区还需要1500个医护人员为居民服务。 「由于大流行造成的损失、通货膨胀率飙升和报销率低，医院正在亏损，我们从2021年开始亏损，如今还在继续」，「现在正在动用我们的储备金，也在寻求借贷以帮助继续支付成本，但最终，这不是能够长久解决的方案。」 UC San Diego Health的首席执行官Patty Maysent说，全州都有医院，距离用完现金还有两三个月或四个月的时间，所有医院领导都表示，他们向医生支付的费用超过了Medicare和 Medi-Cal给予的费用，他们别无选择，若不这样做，将没有足够的人手愿在社区中执业。 CHA主席Carmela Coyle说，加州医院每提供一美元的护理，他们会收到大约75美分，「这听起来感觉很多，但就目前在Medi-Cal计划上的支出而言，这是一个相对小的数额，约佔预算的1%。」 在与新闻记者的电话会议上，她呼吁州领导人能提供15亿美元的临时救济，以防止医院关闭。 「这是迫切需要的，作为一个州，维持医院运营的成本远低于让一间医院倒闭然后重新再恢復，所以支援是值得的。」 Carmela表示，真正的危机和担忧是，如此高比例的关闭危机对整个加州的每个社区都有影响，「这些社区的医疗保健正在受到侵蚀，因为我们正在失去某些服务，医院试图维持生计，无论是关闭产科护理、行为健康服务还是其他，都是社区民众的损失。」 「MLK Community Healthcare」首席执行官Elaine Batchlor说，她的小医院服务于洛杉矶南部的部分社区，长期以来一直是洛县最繁忙的急诊室之一，她说，按照医患比例标准，社区还需要1500个医护人员为居民服务。 「由于大流行造成的损失、通货膨胀率飙升和报销率低，医院正在亏损，我们从2021年开始亏损，如今还在继续」，「现在正在动用我们的储备金，也在寻求借贷以帮助继续支付成本，但最终，这不是能够长久解决的方案。」 UC San Diego Health的首席执行官Patty Maysent说，全州都有医院，距离用完现金还有两三个月或四个月的时间，所有医院领导都表示，他们向医生支付的费用超过了Medicare和 Medi-Cal给予的费用，他们别无选择，若不这样做，将没有足够的人手愿在社区中执业。
MLK Community Hospital says it could soon be unable to pay its bills
MLK Community Hospital, a crucial safety-net facility serving the South Los Angeles area, may run out of money to pay its bills as soon as next year, hospital leaders are warning. The nonprofit hospital, which was established to replace the closed King/Drew Medical Center, lost more than $42 million in the budgetyear that ended in June, according to officials at the privately run facility. The Willowbrook facility was established with a unique funding system that included supplemental payments from the state and county government to keep the hospital afloat. But the funding formula has failed to keep pace with inflation and a steep increase in staffing expenses, among other shortcomings, MLK leaders said. The end of federal aid that had been given to hospitals during the COVID-19 pandemic was another blow, they added. One of MLK’s biggest challenges is the fact that its emergency department has been deluged with four times as many patients as initially expected. That’s a problem because Medi-Cal, the California Medicaid program, does not fully cover the costs for providing emergency services, hospital leaders said. All in all, the hospital said less than half of the revenue in its current $375-million budget comes from billing Medi-Cal and other payers, such as commercial health insurance plans, for its services. “We really couldn’t operate the hospital based on what we’re able to bill payers for,” said Dr. Elaine Batchlor, chief executive of MLK Community Healthcare, which runs the hospital. That gap was supposed to be closed in part with supplemental funding from Medi-Cal thanks to a state law enacted more than a decade ago to ensure the hospital would be financially sustainable. That hasn’t worked out as planned. Hospital officials say the size of that supplement is set ahead of time based on costs incurred in the previous year — and does not increase if its actual costs prove to be higher. MLK also receives a county supplement, but that is not adjusted for inflation, they said. California runs a program to help fund hospitals that serve poor patients, but MLK is unable to tap into it. Hospital officials said its Medi-Cal supplement was set up as an alternative to the state program to ensure MLK didn’tpull funds away from other safety-net medical facilities.
MLK Community Hospital in Willowbrook opened eight years ago to replace King/Drew Medical Center. (Myung J. Chun / Los Angeles Times)
King/Drew Medical Center, which MLK replaced, lost its national accreditation in 2005 after repeated lapses in patient care. Federal regulators faulted King/Drew for giving patients the wrong drugs or dosages and using stun guns to subdue psychiatric patients. A Times investigation found that staff errors and neglect led to patient injuries and deaths. Eight-year-old MLK Community Hospital, in turn, has touted its record for safety and quality: It boasts a five-star quality rating from federal regulators, has an “A” grade from a nonprofit focused on patient safety, and has been lauded for its maternity care. “We have fulfilled our commitment to the community to provide high-quality, safe care,” Batchlor said. “But the funding model that was created ... is not working anymore.” When that model was drawn up, MLK was expected to handle 25,000 emergency department visits a year, hospital officials said. Last year, it tallied more than 100,000 such visits, ranking it among the busiest in the country. With only 29 rooms, the emergency department has been forced to carve out unconventional treatment spaces in chairs and on gurneys.
Rod Berryman waits in the ambulance bay outside the emergency department at MLK Community Hospital last year. (Francine Orr / Los Angeles Times) The surging numbers of patients at MLK have added to hospital expenses because mandated nurse-to-patient ratios required it to hire hundreds more nurses, Batchlor said. In the last fiscal year, MLK was more than $20 million over budget for temporary labor, she said, “and most of that is traveler nurses.” The new hospital is about one-third the size of the medical center it replaced. The downsizing drew some criticism when MLK opened eight years ago, but experts at the time said the reduced capacity reflected the idea that the hospital should not become the community’s default provider of day-to-day care. The shortage of other options has undermined that plan. Roughly 40% of its emergency department visits could have been handled in an outpatient clinic, MLK officials estimate, but patients have not been able to easily access that care in South L.A. Financial margins for California hospitals remain lower than they were before the pandemic, and the data “paint a picture of a tremendously challenging future,” according to a study published this year in Health Affairs Scholar. Economic pressures have already forced the closure of Madera Community Hospital in rural Central California and spurred Beverly Hospital in Montebello to file for bankruptcy protection this spring. The ongoing strain “will likely lead hospitals to raise prices to their commercially insured patients,” the study concluded. But MLK has few of those patients. One of the reasons the hospital has struggled is that the bulk of its patients rely on public programs like Medi-Cal , which pay less than private insurance. MLK’s heavy reliance on government reimbursement means “they have very little wiggle room,” said Glenn Melnick, a health economist at USC. “They are in a tough situation. It’s not like they can raise their prices to offset rising costs.” On top of that, MLK officials said many Medi-Cal patients stay longer in the hospital than needed because it is hard to get timely transfers to other facilities. That drives up costs for MLK for caring for those patients, but not the corresponding payments from health plans, Batchlor said. And the hospital has to bolster pay for private physicians who won’t work for Medi-Cal rates, spending millions of dollars each year to bring them up tomarket rates, Batchlor said. Christopher M. Whaley, a health policy expert at the Brown University School of Public Health, said California hospitals can be divided into “the haves and the have-nots,” with community hospitals falling squarely in the second category. Large health systems have been acquiring physician practices and funneling commercially insured patients into their hospitals, Whaley said. It “does a lot to further inequities and disparities,” he said, because it deprives community hospitals of those higher-reimbursement patients. MLK Community Hospital set up a triage tent outside its emergency department last year to accommodate an influx of patients. (Francine Orr / Los Angeles Times) The Willowbrook hospital snagged a temporary reprieve with a $14-million state loan for hospitals in financial distress. Batchlor said it would help MLK make it through the coming winter but not fix its deeper problems. Hospital leaders are pushing for L.A. County to increase its payments to the hospital to account for inflation. They also want the state to rework its financial supplements and increase funding for visits to the emergency department. If nothing changes, Batchlor said, MLK will be forced to slash services and eventually close its doors. She was dubious that MLK could go the route of Beverly Hospital, which was acquired by Adventist Health this fall after the Montebello facility sought bankruptcy protection. MLK “isn’t a hospital that’s going to generate significant profit for a health system,” Batchlor said. County Supervisor Holly Mitchell, who represents Willowbrook, said MLK’s funding system must be revisited to better support a hospital that has “stepped up to the plate” to serve its community. MLK “must not only survive but continue to thrive,” she said. “And we have to figure out how to make that happen.” https://www.latimes.com/california/story/2023-11-10/mlk-financial-trouble
那些不看NP 的人，他们只能住在大城市。 小城市的医疗资源会萎缩
美国执业护士需求快速增长，成为解决初级保健困境的主力军！
美国执业护士协会(AANP)主席指出，执业护士(NP)的需求正迅速增长，原因是近1亿美国人无法获得初级保健服务。该国家组织表示，NP需求的持续增长将是2023年医疗保健行业的主要趋势之一。
AANP已确定了五个值得关注的重要医疗保健趋势：
01 对NP的需求趋势在不断上涨
AANP指出，美国人口老龄化、传染病增加和慢性病增加是导致NP需求增长的重要因素之一。
目前，我们拥有35.5万名NP，并且我们将继续稳步增加。”美国执业护士协会(AANP)主席Kapu表示：“我们预计在2021年至2031年期间，NP数量将增长46%。
据美国新闻与世界报道，NP在顶级医疗保健工作中排名第一，在所有工作中排名第二。
根据她的说法：
“我们面临着巨大的需求，因为目前有着9900万名美国人无法获得初级保健，并且等待时间比以往任何时候都要长。NP正在积极努力满足这些访问需求。无论是在农村环境、城市环境、医院、诊所，还是通过远程医疗、移动站点、专业护理设施和学校，我们都能看到NP的数量在增加，以帮助满足这种需求。”
02 1亿人生活在初级保健短缺地区，持续上升
AANP指出，美国人口老龄化、传染病增加和慢性病增加是导致NP需求增长的重要因素之一。
根据AANP的数据，农村地区的初级保健短缺问题更为严重。在过去的十年里，超过130家医院关闭，仅2020年就有近20家。
最近的一项AANP调查显示，在过去的12个月中，近50%的患者等待医疗预约的时间超过一个月，而25%的患者等待时间超过两个月。Kapu指出，随着农村地区执业医生数量的减少，NP正有针对性地进入这些服务欠缺的地区。
全实践管理局 (FPA) 授权NP可以对患者进行评估、诊断、开处方以及解读诊断测试，并在州护理委员会的独家许可权限下启动和管理治疗。这意味着NP不需要与医生签订州规定的合同作为获得国家许可的条件。
03 NP在疾病研究、诊断和治疗中领导
Kapu表示，NP正在引领各种疾病的诊断和治疗，并积极参与新疗法的开发和对抗新兴疾病的研究。
她说：“我们已经看到NP在临床专业知识方面的提升，因此组织和协会正在寻找NP来帮助发表研究和文章，或者通过出版物和演讲在全国范围内展示他们的研究成果。”
为了鼓励会员承担领导角色，AANP提供持续课程，培养领导技能。
04 越来越多的州，允许患者直接找NP
目前越来越多的州（包括华盛顿特区在内的26个州）正在颁发全权执业（FPA）给护理从业人员，使患者能够直接寻求护士执业者提供医疗服务，而无需与医生签署协议。
在大流行期间，FPA得到了进一步的推动，各州临时停止了执业协议的要求，允许患者直接通过护士执业者获得护理服务。尽管现在一些州的行政命令已经到期，但马萨诸塞州、特拉华州、堪萨斯州和纽约州这四个州选择永久采用FPA。
05 扩大了患者获得心理健康服务的机会
1.58亿人生活在精神卫生保健专业人员短缺地区，NP带头满足这一护理需求。
美国护理学院协会的数据显示，过去十年间，美国新增了近100个精神科心理健康执业护士（PMHNP）项目，培养了13,000多名合格毕业生。
而根据2022年的研究，2011年至2019年期间，治疗Medicare受益人的NP数量增长了162%，相比之下，治疗Medicare患者的精神病医生数量减少了6%。
加州五分之一医院有倒闭危机 CHA主席吁政府提供15亿美元援助
Consulting公司Kaufman Hall在加州医院协会（简称CHA）委託的一份报告中表示，由于财务挑战日益严峻，数十家加州医院（五分之一）面临倒闭风险，行业领袖呼吁国家援助。
数十家加州医院面临关闭风险，行业领袖在呼吁援助。
许多医院至今其实尚未从大流行的损失中得到足够弥补，而Medi-Cal和Medicare的报销情况基本停滞不前，而现在服务成本一直飙升。
Carmela表示，真正的危机和担忧是，如此高比例的关闭危机对整个加州的每个社区都有影响，「这些社区的医疗保健正在受到侵蚀，因为我们正在失去某些服务，医院试图维持生计，无论是关闭产科护理、行为健康服务还是其他，都是社区民众的损失。」
「MLK Community Healthcare」首席执行官Elaine Batchlor说，她的小医院服务于洛杉矶南部的部分社区，长期以来一直是洛县最繁忙的急诊室之一，她说，按照医患比例标准，社区还需要1500个医护人员为居民服务。
「由于大流行造成的损失、通货膨胀率飙升和报销率低，医院正在亏损，我们从2021年开始亏损，如今还在继续」，「现在正在动用我们的储备金，也在寻求借贷以帮助继续支付成本，但最终，这不是能够长久解决的方案。」
UC San Diego Health的首席执行官Patty Maysent说，全州都有医院，距离用完现金还有两三个月或四个月的时间，所有医院领导都表示，他们向医生支付的费用超过了Medicare和 Medi-Cal给予的费用，他们别无选择，若不这样做，将没有足够的人手愿在社区中执业。
CHA主席Carmela Coyle说，加州医院每提供一美元的护理，他们会收到大约75美分，「这听起来感觉很多，但就目前在Medi-Cal计划上的支出而言，这是一个相对小的数额，约佔预算的1%。」
在与新闻记者的电话会议上，她呼吁州领导人能提供15亿美元的临时救济，以防止医院关闭。
「这是迫切需要的，作为一个州，维持医院运营的成本远低于让一间医院倒闭然后重新再恢復，所以支援是值得的。」
Carmela表示，真正的危机和担忧是，如此高比例的关闭危机对整个加州的每个社区都有影响，「这些社区的医疗保健正在受到侵蚀，因为我们正在失去某些服务，医院试图维持生计，无论是关闭产科护理、行为健康服务还是其他，都是社区民众的损失。」
「MLK Community Healthcare」首席执行官Elaine Batchlor说，她的小医院服务于洛杉矶南部的部分社区，长期以来一直是洛县最繁忙的急诊室之一，她说，按照医患比例标准，社区还需要1500个医护人员为居民服务。
「由于大流行造成的损失、通货膨胀率飙升和报销率低，医院正在亏损，我们从2021年开始亏损，如今还在继续」，「现在正在动用我们的储备金，也在寻求借贷以帮助继续支付成本，但最终，这不是能够长久解决的方案。」
UC San Diego Health的首席执行官Patty Maysent说，全州都有医院，距离用完现金还有两三个月或四个月的时间，所有医院领导都表示，他们向医生支付的费用超过了Medicare和 Medi-Cal给予的费用，他们别无选择，若不这样做，将没有足够的人手愿在社区中执业。
2007年马丁‧路德‧金─德鲁医疗中心（Martin Luther King, Jr./Drew Medical Center）关闭之后留下的空白。2007年，该中心由于医护服务差而被称为“杀手金”（Killer King），最终失去了联邦政府基金支持而关闭。之后该区每年约有5万人次诊疗移往别处就医。
2010年，洛县和加大达成协议，在该地区建一所新的医院，由洛县负责建筑和装修医院，并提供额外基金支持医保和穷人救护，而加大则提供医护人员。双方之后委托年马丁‧路德‧金─洛杉矶医护公司经营管理该院。
几经周折，新的马丁‧路德‧金医院 (MLK) 终于即将开张，代表南洛杉矶的县政委员托马斯（Mark Ridley-Thomas）表示，新医院与老医疗中心有很多不同，新院有新设备、新技术、新医护人员和新的管理层。医院的CEO巴特勒（Elaine Batchlor）说，该院拥有世界级医护团队，高水平的领导和多元化多语言的工作人员等，将大大缩小该地区与其他地区存在的医护差距。
MLK Community Hospital says it could soon be unable to pay its bills
MLK Community Hospital, a crucial safety-net facility serving the South Los Angeles area, may run out of money to pay its bills as soon as next year, hospital leaders are warning.
The nonprofit hospital, which was established to replace the closed King/Drew Medical Center, lost more than $42 million in the budget year that ended in June, according to officials at the privately run facility.
The Willowbrook facility was established with a unique funding system that included supplemental payments from the state and county government to keep the hospital afloat. But the funding formula has failed to keep pace with inflation and a steep increase in staffing expenses, among other shortcomings, MLK leaders said. The end of federal aid that had been given to hospitals during the COVID-19 pandemic was another blow, they added.
One of MLK’s biggest challenges is the fact that its emergency department has been deluged with four times as many patients as initially expected. That’s a problem because Medi-Cal, the California Medicaid program, does not fully cover the costs for providing emergency services, hospital leaders said.
All in all, the hospital said less than half of the revenue in its current $375-million budget comes from billing Medi-Cal and other payers, such as commercial health insurance plans, for its services.
“We really couldn’t operate the hospital based on what we’re able to bill payers for,” said Dr. Elaine Batchlor, chief executive of MLK Community Healthcare, which runs the hospital.
That gap was supposed to be closed in part with supplemental funding from Medi-Cal thanks to a state law enacted more than a decade ago to ensure the hospital would be financially sustainable.
That hasn’t worked out as planned. Hospital officials say the size of that supplement is set ahead of time based on costs incurred in the previous year — and does not increase if its actual costs prove to be higher. MLK also receives a county supplement, but that is not adjusted for inflation, they said.
California runs a program to help fund hospitals that serve poor patients, but MLK is unable to tap into it. Hospital officials said its Medi-Cal supplement was set up as an alternative to the state program to ensure MLK didn’t pull funds away from other safety-net medical facilities.
King/Drew Medical Center, which MLK replaced, lost its national accreditation in 2005 after repeated lapses in patient care. Federal regulators faulted King/Drew for giving patients the wrong drugs or dosages and using stun guns to subdue psychiatric patients. A Times investigation found that staff errors and neglect led to patient injuries and deaths.
Eight-year-old MLK Community Hospital, in turn, has touted its record for safety and quality: It boasts a five-star quality rating from federal regulators, has an “A” grade from a nonprofit focused on patient safety, and has been lauded for its maternity care.
“We have fulfilled our commitment to the community to provide high-quality, safe care,” Batchlor said. “But the funding model that was created ... is not working anymore.”
When that model was drawn up, MLK was expected to handle 25,000 emergency department visits a year, hospital officials said. Last year, it tallied more than 100,000 such visits, ranking it among the busiest in the country. With only 29 rooms, the emergency department has been forced to carve out unconventional treatment spaces in chairs and on gurneys.
The surging numbers of patients at MLK have added to hospital expenses because mandated nurse-to-patient ratios required it to hire hundreds more nurses, Batchlor said. In the last fiscal year, MLK was more than $20 million over budget for temporary labor, she said, “and most of that is traveler nurses.”
The new hospital is about one-third the size of the medical center it replaced. The downsizing drew some criticism when MLK opened eight years ago, but experts at the time said the reduced capacity reflected the idea that the hospital should not become the community’s default provider of day-to-day care.
The shortage of other options has undermined that plan. Roughly 40% of its emergency department visits could have been handled in an outpatient clinic, MLK officials estimate, but patients have not been able to easily access that care in South L.A.
Financial margins for California hospitals remain lower than they were before the pandemic, and the data “paint a picture of a tremendously challenging future,” according to a study published this year in Health Affairs Scholar. Economic pressures have already forced the closure of Madera Community Hospital in rural Central California and spurred Beverly Hospital in Montebello to file for bankruptcy protection this spring.
The ongoing strain “will likely lead hospitals to raise prices to their commercially insured patients,” the study concluded. But MLK has few of those patients.
One of the reasons the hospital has struggled is that the bulk of its patients rely on public programs like Medi-Cal , which pay less than private insurance.
MLK’s heavy reliance on government reimbursement means “they have very little wiggle room,” said Glenn Melnick, a health economist at USC. “They are in a tough situation. It’s not like they can raise their prices to offset rising costs.”
On top of that, MLK officials said many Medi-Cal patients stay longer in the hospital than needed because it is hard to get timely transfers to other facilities. That drives up costs for MLK for caring for those patients, but not the corresponding payments from health plans, Batchlor said.
And the hospital has to bolster pay for private physicians who won’t work for Medi-Cal rates, spending millions of dollars each year to bring them up to market rates, Batchlor said.
Christopher M. Whaley, a health policy expert at the Brown University School of Public Health, said California hospitals can be divided into “the haves and the have-nots,” with community hospitals falling squarely in the second category.
Large health systems have been acquiring physician practices and funneling commercially insured patients into their hospitals, Whaley said. It “does a lot to further inequities and disparities,” he said, because it deprives community hospitals of those higher-reimbursement patients.
The Willowbrook hospital snagged a temporary reprieve with a $14-million state loan for hospitals in financial distress. Batchlor said it would help MLK make it through the coming winter but not fix its deeper problems.
Hospital leaders are pushing for L.A. County to increase its payments to the hospital to account for inflation. They also want the state to rework its financial supplements and increase funding for visits to the emergency department.
If nothing changes, Batchlor said, MLK will be forced to slash services and eventually close its doors. She was dubious that MLK could go the route of Beverly Hospital, which was acquired by Adventist Health this fall after the Montebello facility sought bankruptcy protection.
MLK “isn’t a hospital that’s going to generate significant profit for a health system,” Batchlor said.
County Supervisor Holly Mitchell, who represents Willowbrook, said MLK’s funding system must be revisited to better support a hospital that has “stepped up to the plate” to serve its community.
MLK “must not only survive but continue to thrive,” she said. “And we have to figure out how to make that happen.”
https://www.latimes.com/california/story/2023-11-10/mlk-financial-trouble