But all the king’s horses and all the king’s men still couldn’t put Humpty Dumpty back together again.

The healthcare sector has faced several Chapter 11 bankruptcy filings this year as a result of severe industry headwinds, despite a study claiming fewer healthcare providers are expected to file bankruptcy in 2024 compared to 2023. Healthcare restructuring advisory firm Gibbins Advisors reported in its Interim 2024 Report in August that 27% fewer firms were set to file bankruptcy in 2024 compared to 2023. But some major healthcare providers have recently filed for bankruptcy since that study was released. Hospital Staff Essential Businesses Lead Hospitals and health center operator CarePoint Health Systems, which operates as a safety net for a large underprivileged community, on Nov. 4 filed for Chapter 11 protection in the U.S. Bankruptcy Court for the District of Delaware to reorganize its unsustainable debt. The New Jersey-based debtor faced financial and liquidity challenges resulting from unreimbursed Covid-19 expenditures and inadequate state government funding to cover a disproportionately large number of uninsured and undocumented patients who are admitted through its emergency rooms. Following that bankruptcy filing, Wellpath Holdings, a leading healthcare provider for prisons and mental health facilities, and 38 affiliates on Nov. 11 filed for Chapter 11 protection in the U.S. Bankruptcy Court for the Southern District of Texas to reorganize its businesses and sell certain assets to an ad hoc group of its prepetition lenders. The Nashville, Tenn., debtor blamed rising operating and labor costs, increased liability insurance expenses, underperforming contracts, and declining liquidity for causing its financial distress. Finally, CareMax Inc., (CMAX) an operator of clinical care centers providing a comprehensive range of medical services, filed for Chapter 11 bankruptcy protection on Nov. 17 seeking a sale of substantially all of its assets. Business Closing Filing Bankruptcy Chapter 11 Judge The Miami, Fla.-based debtor listed $390 million in assets and $639 million in debts in its petition, which was filed in the U.S. Bankruptcy Court for the Northern District of Texas. Its largest unsecured creditors include Health Catalyst Inc., owed $3.38 million; Elevance Health Inc., owed $846,535; and Foresee Medical Inc., owed $722,222. The debtor reported net losses of $37.8 million for the year ending Dec. 31, 2022, and $683.3 million for the year ending Dec. 31, 2023. The company will seek court approval of $122 million in debtor-in-possession financing from its prepetition lenders, consisting of $30.5 million in new money and a rollup of prepetition debt. CareMax cited a series of systemic and unique challenges over the last two years that resulted in a substantial increase in the cost of doing business, which outpaced revenue gains, according to a declaration from Chief Restructuring Officer Paul Rundell. Among the challenges were industrywide headwinds that depressed profits, inflation that increased labor and operational costs, and various economic factors that constrained the company's ability to raise new capital. The company also cited lingering effects from the Covid-19 pandemic and lagging industry reimbursement rates, which resulted in lower net patient revenue. The company's growth strategy required large sums of capital and substantial operating expenses, according to court papers. The debtor secured prepetition debt with costs that increased due to rising interest rates that led to increased debt service payments, making it difficult to comply with covenants under its credit agreement. In February 2024, the debtor began defaulting on its prepetition debt, which consisted of about $35 million, according to court papers. The debtor sought strategic alternatives such as an out-of-court restructuring and a prepetition sale of its assets, but opted for an in-court solution. The debtor filed a prearranged Chapter 11 with a restructuring support agreement that calls for a sale of the company in a Section 363 auction. The debtor has reached an agreement to sell its Medical Shared Savings Program under its management services organization to Revere Medical, through its bankruptcy filing, according to Nov. 17 statement. The company will name a stalking-horse bidder in a bidding procedures motion for its operating clinic business that is expected to be filed on or around Nov. 24, according to court papers. CareMax operates 46 clinical centers with about 1,100 employees and 260,000 patients with facilities in Florida, New York, Tennessee, and Texas.

@LuFins-Dad said in Democrats have an empathy problem: Democrats Have An Empathy Problem of Their Own It's time for Dems like me to do the hard work of actually listening to Trump voters.. So let’s start here. I can read this two different ways. The author could mean that it’s hard to accept our own culpability and shortcomings, and that’s the hard work… Or they could mean the very act of listening to Trump voters is onerous. I think he meant the former. I also question why nobody is addressing the 35% of registered voters that chose not vote this cycle or chose to vote 3rd party/independent. It seems to me that there is a quite large segment of the population that is not involved in the process and maybe we should ask why? I guess he's addressing what is under his control, which is the messaging and attitude of his own tribe. If he can improve that, the improved messaging will speak to that 35%.

Maybe they need to work for the RNC? LOL

That author also explained that "the so-called normal distribution of statistics assumes that there are default humans who serve as the standard that the rest of us can be accurately measured against." This sort of long-standing attitude on the left is what made it so hilarious when in unison, that side got so excited to call the right "weird". For whatever reason, that strategy went away after a couple weeks, maybe in a fit of self-awareness of how directly opposed it was to their claimed principles. But I've heard it spoken of fondly to this day. Some on the left still miss being able to say it, and they think the election would have gone better if they had stuck to it.

My wife would've wanted to throw away all the bags. Then sell the house.

Food pyramid.

@Doctor-Phibes said in Does MTG make sense?: I do not want to see any of them dancing in the sunlight. Almost makes me want to subscribe to an AI that could generate such a video. Almost.

@George-K said in Unsafe cities: How much of that is "know your neighborhood?" In New Orleans, there were some areas that I would not consider going to, even in daylight. That's just common sense in any city. Chicago, however, seems to have become more .. unpleasant... in what used to be "safe" locations. The Loop, Gold Coast, etc have seen a real uptick in crime. Staying in San Francisco was a bit of an eye-opener for me. I was in a pretty upmarket-seeming downtown hotel with work, there were pictures of Elvis staying there and what-have-you, presumably for the $50 all-you-can-eat breakfast and Moet & Chandon vending machines (I kid you not). If you stepped outside and turned left you could find yourself in a whole mess of trouble pretty quickly. If you turned right, it was OK, but still just OK. I certainly wouldn't go there for fun.

@89th you’re acutie.

https://x.com/boneGPT/status/1858379684104356041 "Deitz Nuüzen..." LOL (Actually, it should be "Dietz")

@Doctor-Phibes said in Joe goes to kiss Hitler's ring: I never cease to be surprised that people have the time or inclination to watch this stuff every day. About 10 years ago I would eat my breakfast watching the first 10-15 min of Morning Joe before leaving for work. It was a decent show... quick discussion of headlines, some opinions, good banter. But it seems like it's really gone down the anti-GOP/Trump drain since then.

That actually sounds like a suicide.

Seems rather dangerous to carry in your pocket.

https://www.npr.org/2024/04/22/1245858737/gen-z-trade-vocational-schools-jobs-college

I've been preaching that for a while. In my career, I've had two patients aspirate gastric contents. One was a 12 (?) year old having foot surgery. He had been NPO for 8 hours, and I did the case without an endotracheal tube. It was within the standard of care. He coughed up last night's dinner. Spent the night in the hospital for a presumably outpatient procedure. No long-term sequelae. The other was a guy (I still remember his name, 30 years later) who had some ENT procedure. At the end of surgery, he coughed up last night's pizza. I remember the green peppers. He did not, AFAIK, aspirate, but it scared the crap out of me. Not my case, but there was a patient who I pre-oped who had a hiatal hernia. My partner put her to sleep, and before he could intubate her, all the stuff in her stomach came up and filled her oropharynx. A goodly amount ended up going into her lungs. She died about 10 days later - in the ICU on a ventilator. I was sued, as was my partner. I was dropped. He settled. Instead, the new ASA guidanceopens in a new tab or window states that most patients can continue their medication up until the day of surgery but should follow a liquid diet for 24 hours before the procedure, depending on specific circumstances. For decades we've been taught that pregnant women have delayed gastric emptying, and we should treat them all as having a full stomach. Now we're being told that it's probably OK. I disagree. Glad I'm retired and I don't have to make these decisions. I can't imagine going to the GI lab to give anesthesia for an endoscopy and, because the patient is on an GLP-1 agonist, arguing with the GI doc that I need to secure the airway because there's STILL STUFF IN THE STOMACH. Sorry for yelling. But, as they say, these days it's not my circus and not my monkeys. There are few things scarier for an anesthesiologist than opening the patient's mouth, inserting a laryngoscope and having half a liter of semi-solid gastric contents well up and fill the pharynx. As a former colleague of mine said (paraphrasing), "If you think the stomach might be full, you should treat it as if it definitely is." This is a hill I would have died on.