New Hospital Facility in GF

[iramurphy]

27 minutes ago, SiouxVolley said:

https://www.statnews.com/pharmalot/2016/11/22/side-effects-emergency-room/

Pharmaceutical side effects are getting to be almost a majority of ER visits now.  In favor of genetic medicines to correct those issues, but diabetes, cardio, kidney, and hypertension can have natural based curses that most MDs reject because they don’t want to be sued because the patient won’t follow a strict routine.

My evidence is life experience.  Many doctors reject Jesus too because there isn’t enough evidence.

The study you refer to was published by the AMA journal which you claim is beholding to the pharmaceutical industry. If your claim is true why would they publish the article?  The study is valid but your claim of a “huge fraction” of ER visits are due to adverse drug events is proven inaccurate by your own reference. 9.7 per thousand visits for those over 65 and 3.1 per thousand visits are both less than 1% not a huge fraction as you claim nor is less than 1% a majority of visits. Do you even know how to read or understand a scientific study?  I assume you mean generic medication instead of “genetic “ which is the term you use. Our computer programs defer to generic medication automatically. One must manually override to write for a brand name medication. Your “natural based curses” you refer to make no sense. I assume you meant cures but you never tell us what they are. Scientists and Medical providers have a moral and ethical obligation to share all scientific and medical breakthroughs especially if they are safer, more effective, less expensive etc. Unfortunately, these “practitioners “ seem to want to keep their secrets to themselves.  Ask these folks what the mark-up is on their unproven products. It’s significant. The pharmaceutical industry has nothing on these folks. I have worked or studied in hospitals around the country and in the military and other countries.  I have very seldom met a physician who doesn’t believe in God. Your “life experience” seems to be a bit lacking. Your arguments are shallow and flawed. Making medical and scientific claims without evidence only hurts the naturopathic movement. 

[SiouxVolley]

49 minutes ago, iramurphy said:

The study you refer to was published by the AMA journal which you claim is beholding to the pharmaceutical industry. If your claim is true why would they publish the article?  The study is valid but your claim of a “huge fraction” of ER visits are due to adverse drug events is proven inaccurate by your own reference. 9.7 per thousand visits for those over 65 and 3.1 per thousand visits are both less than 1% not a huge fraction as you claim nor is less than 1% a majority of visits. Do you even know how to read or understand a scientific study?  I assume you mean generic medication instead of “genetic “ which is the term you use. Our computer programs defer to generic medication automatically. One must manually override to write for a brand name medication. Your “natural based curses” you refer to make no sense. I assume you meant cures but you never tell us what they are. Scientists and Medical providers have a moral and ethical obligation to share all scientific and medical breakthroughs especially if they are safer, more effective, less expensive etc. Unfortunately, these “practitioners “ seem to want to keep their secrets to themselves.  Ask these folks what the mark-up is on their unproven products. It’s significant. The pharmaceutical industry has nothing on these folks. I have worked or studied in hospitals around the country and in the military and other countries.  I have very seldom met a physician who doesn’t believe in God. Your “life experience” seems to be a bit lacking. Your arguments are shallow and flawed. Making medical and scientific claims without evidence only hurts the naturopathic movement. 

The study referenced 60% of older citizens that go the the emergency room go because of pharmaceuticals.  The % you used is just the % of the general population regardless if they go the the ER, as manipulated by the AMA.

Genetic medicines is what is was I  referring too, as there has been a huge increase in biotech knowledge and manufacturing ability.

MDs are not healing gods, much as you disagree.  Most MDs just want a “stable” patient, not a healed one.

Muscle response testing is what I use, which uses the bodies own nervous systems, and that can tell if a pharmaceutical or even artificial food has a dangerous effect or an herb or other foods having a beneficial one.  But I wouldn’t  bet on you actually investigating it because chiropractors are so beneath your dignity.

 

[SiouxVolley]

Just for our resident doctor, here is another study that says side effects of pharmaceuticals result in million of ER visits every year.

https://www.premierphysiciannet.com/About-Us/News-Center/Press-Releases/Millions-of-Americans-Experience-Side-Effects-from-Medication/

[iramurphy]

1 hour ago, SiouxVolley said:

Just for our resident doctor, here is another study that says side effects of pharmaceuticals result in million of ER visits every year.

https://www.premierphysiciannet.com/About-Us/News-Center/Press-Releases/Millions-of-Americans-Experience-Side-Effects-from-Medication/

I don’t think anyone disputes millions of people experience side effects from medications every year. My colleagues and patients who are Chiropractors would disagree with your generalization. I refer to chiropractors regularly and we consult with each other regularly.  They have an area of expertise that can benefit my patients including acupuncture. We work together and can walk down the next hall to consult each other. Your claims about how I feel and think are as inaccurate as your muscle testing voodoo. I don’t know of any good chiropractors trying to convince unsuspecting patients of the goofy stuff you are doing. In my residency we had an annual update from one of the staff who had taught in one of the chiropractic programs. He kept us up to date on changes and advances in chiropractic practice and warned us to stay away from people like you. He felt your bs was fraud. I don’t work with Drs who think they are God’s nor any who don’t want to help their patients get well. Your anti traditional medicine rhetoric is nothing new and usually comes from those who can’t build up a busy practice providing traditional chiropractic care. They are often “anti Vaxers” and usually sell their supplements, mega vitamins, and herbs out of their own office at a premium price. We offer biogenetic testing to all of our patients for $49 and we adjust our recommendations and treatments based on their genetics. Having a patient hold their arms out and thinking one can diagnose what’s in the blood stream based on response to varying amounts of pressure has no factual basis nor evidence to support it. I could do the same video with any of my patients and get the same thing without “adjusting “ the knee. I don’t care what you do as long as you do no harm. If people want to pay you for that more power to you. We have derailed this subject to long, thanks for the entertainment.  

[northernraider]

Well this topic went in an unexpected direction.

[iramurphy]

23 minutes ago, northernraider said:

Well this topic went in an unexpected direction.

Yeah it did, sorry. I couldn’t let some of it go unchallenged. I’m done. 

[Oxbow6]

7 hours ago, iramurphy said:

Yeah it did, sorry. I couldn’t let some of it go unchallenged. I’m done. 

Should we discuss a single payer system since we are at it??

Asking for a friend named Bernie...........

On 6/28/2019 at 9:11 PM, SiouxVolley said:

Sanford Health is merging with a slightly smaller Iowa based healthcare company:  UnityPoint Health.

https://www.argusleader.com/story/news/2019/06/28/sanford-health-announces-massive-merger-plan-unitypoint-health-iowa-south-dakota/1588506001/

Sanford had a goal to buy Twin Cities hospitals, but that apparently feel through.

.......and the HealthParnters and Allina systems in the Cities make Trinity in Minot look like Johns Hopkins if we want to revisit this topic as well.

[Nodak78]

A little off topic.

https://www.argusleader.com/story/news/2019/06/28/sanford-health-lawsuit-alleges-fraud-surgery-wilson-asfora-krabbenhoft/1592565001/?fbclid=IwAR0vtgHG3met2p8gJp5Z5DyuW0ZdqAiEIstgeVkN0Dakm0oGVlbXor2eJOc

 

[UNDBIZ]

On 6/30/2019 at 10:27 AM, Nodak78 said:

A little off topic.

https://www.argusleader.com/story/news/2019/06/28/sanford-health-lawsuit-alleges-fraud-surgery-wilson-asfora-krabbenhoft/1592565001/?fbclid=IwAR0vtgHG3met2p8gJp5Z5DyuW0ZdqAiEIstgeVkN0Dakm0oGVlbXor2eJOc

 

Quote

Sanford Health and one of its most lucrative surgeons have been accused of defrauding the federal government out of millions of dollars while also harming patients in a stunning complaint filed in federal court.....

The filing says that Sanford’s executive leadership, including President and CEO Kelby Krabbenhoft, and doctors who were supposed to ensure patient safety, ignored repeated warnings and complaints that Asfora was performing unnecessary surgeries.

[iramurphy]

On 7/1/2019 at 11:16 AM, UNDBIZ said:

 

This was rather disturbing, but then I learned “the rest of the story “.  Apparently the “complaint” is years old. It was investigated internally and by the state board of medical examiners and found to be without merit.  I don’t know anything else about the issue other than these cases can drag on for years. Media recently jumped on this. They should have included it had already been reviewed by the SDak board of medical examiners and found to be without merit. 

[MrEdway]

https://www.grandforksherald.com/business/healthcare/4822595-Altru-Health-System-scales-back-plans-for-its-new-Grand-Forks-hospital

Seems a little drastic.

[SiouxFan100]

Buy some hats

[gfhockey]

I was told they couldn’t sell enough bonds 

[Cratter]

Altru continues to impress the community.

[yzerman19]

3 hours ago, gfhockey said:

I was told they couldn’t sell enough bonds 

Highly unlikely.  A bond issue of that scale would be marketed by the investment bank they chose- historically in NY or Chicago, which would have no trouble over -subscribing the issue if priced correctly.  Which the bank would help them do.  Tax-exempt revenue bonds are generally very attractive to the bond market.  

[Oxbow6]

1 hour ago, Cratter said:

Altru continues to impress the community.

Mayo pulls the strings

[gfhockey]

22 minutes ago, yzerman19 said:

Highly unlikely.  A bond issue of that scale would be marketed by the investment bank they chose- historically in NY or Chicago, which would have no trouble over -subscribing the issue if priced correctly.  Which the bank would help them do.  Tax-exempt revenue bonds are generally very attractive to the bond market.  

They were downgraded meaning higher interest rates meaning higher payments. They couldn’t afford the debt payment along with not being able to sell all the bonds. I know lots of local places turned them down

[yzerman19]

As an industry expert, Here are some notables to consider:

1.  Altru is remaining independent, which creates G & A pressure in terms of scale and shared services.  Simply put, administration costs more per service because of this Costs more than it does at larger systems.  
2.  Serving the entire community as an independent requires a breadth of services that limits the opportunity to focus Solely on centers of excellence with strong margins.  In other words, they have some major loss leaders on services important to the region.  They could jettison some of those and make people drive to Fargo- they would if they were for-profit or part of say Sanford.  The investment required for related tech is also costly with a longer payback period due to less usage.

3. Cost of care focus from payors as well as technology And care advances have tilted the model to lower margin office and outpatient treatment.  Gone are the days of big loss leading pcp network to feed profitable specialty to feed lucrative admissions.  Volume of lucrative admissions is declining.  Think OP ortho- prime example.

4.  Govt payments I.e. Medicare and Medicaid doesn’t cover costs and is tightening.  The single largest payor for all delivery systems doesn’t pay the rent, is tightening, and is a growing % of services with an aging population.  Revenue forecast not looking so hot.

5.  Skilled labor costs continues to put pressure on mid-market regionals like Altru.  Nursing and physician markets are tight.  Their market rate is not benchmarked to the local wage structure.  
 

Bottom line is operating pressures that have turned many smaller community hospitals into nothing more than birthing centers and triage are progressing up market.  Altru’s commitment to stay locally owned creates additional challenges economically, but also keeps jobs and decision making in GF.  
 

I think they are being judicious given the environment.  
 

As for quality of care and experience issues for patients, that’s a separate animal.  I’m only speaking to the business side of the industry.

[yzerman19]

4 minutes ago, gfhockey said:

They were downgraded meaning higher interest rates meaning higher payments. They couldn’t afford the debt payment along with not being able to sell all the bonds. I know lots of local places turned them down

So...not sure what local places would be involved in a discussion of the initial subscription of a bond issue.  Perhaps in the “friends” clause they would be guaranteed some bonds.  For the record, I once worked on the trading desk of a municipal bond (including healthcare revenue bonds) underwriter, so I’m pretty well versed in the process.  You are correct that a downgrade changes the market expectation of interest.  However debt is still historically cheap, and bond insurance is also a common solution to fear of default.  I don’t really feel like crunching the numbers on cash flow this morning- I’m enjoying my coffee and the fact the Sioux are #1 in the Pairwise.  
To be in the situation you describe, they would’ve had to have abandoned the industry standard approach as well as their historical approach to their detriment.    

[gfhockey]

It’s business 101. Try running ur own business

[yzerman19]

20 minutes ago, gfhockey said:

It’s business 101. Try running ur own business

It is vastly more likely that they made this decision based on industry trends and their own financial plan than an inability to place bonds.  My point is NOT about the financial position of Altru- as you can see by my other post, there are many reasons to be conservative.  My point is that it is improbable that they couldn’t get the bonds placed.  
 

as for running ones own business- tons of respect for the entrepreneur.  I will likely consider running my own business when I finish running this $14B one.
 

 

[MrEdway]

When a project shrinks by 25% just months after it is announced, I have to wonder about the competence of those in charge. But my business career peaked at 12 years of age selling kool ade at Lincoln Park golf course.

[Cratter]

8 minutes ago, MrEdway said:

When a project shrinks by 25% just months after it is announced, I have to wonder about the competence of those in charge. But my business career peaked at 12 years of age selling kool ade at Lincoln Park golf course.

 ....and "shovels" are already in the ground.

This after finally deciding to upgrade after one of its buildings was about to collapse.

[yzerman19]

Better to scale back than live with a bad decision...kinda like getting married.  

healthcare is not a booming industry.  Customers don’t want to have to pay for it...

[SiouxFan100]

Would it be a good thing for Grand Forks if Sanford bought the hospital? Would health care improve, get worse or stay the same?