A Giant Hospital Chain Is Blazing a Profit Trail

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Votaku

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Below is a link to an NY Times expose on HCA, an expanding for-profit nationwide hospital chain that is serving as the model for many other hospital chains, so it's worth a read.


http://www.nytimes.com/2012/08/15/b...ndfall-for-private-equity.html?pagewanted=all


Over-charging bordering on fraud, ordering procedures (including heart surgery) that are not necessary, mass under-staffing, patient quotas forced on doctors, punitive actions against doctors who make any noise.

They managed to hit every single stereotype of a for-profit hospital chain. If this is where the market is going, it is very disturbing...

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Below is a link to an NY Times expose on HCA, an expanding for-profit nationwide hospital chain that is serving as the model for many other hospital chains, so it's worth a read.


http://www.nytimes.com/2012/08/15/b...ndfall-for-private-equity.html?pagewanted=all


Over-charging bordering on fraud, ordering procedures (including heart surgery) that are not necessary, mass under-staffing, patient quotas forced on doctors, punitive actions against doctors who make any noise.

They managed to hit every single stereotype of a for-profit hospital chain. If this is where the market is going, it is very disturbing...

I see both pros and cons. On the one hand, these types of hospitals more aggressively pursue efficiency paradigms that help patients as well as profit margins and desperately need to take place nation wide. On the other hand, it incentivizes these other, more fraudulent, practices.

In other open markets legislature and the legal system defends against the fraudulent practices while allowing the freedom to pursue more appropriate and less damaging cost saving measures.
 
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I see both pros and cons. On the one hand, these types of hospitals more aggressively pursue efficiency paradigms that help patients as well as profit margins and desperately need to take place nation wide. On the other hand, it incentivizes these other, more fraudulent, practices.

In other open markets legislature and the legal system defends against the fraudulent practices while allowing the freedom to pursue more appropriate and less damaging cost saving measures.

When I first started reading the article, it looked sensible. Turn away people from the ER with silly, non-emergency issues or if they insist on staying, have them pay out-of-pocket for their hypochondria. A lot of what's mentioned past that, such as a doctor turning away a boy with a deep cut just because it wasn't bleeding profusely, seems downright abusive. By the time you get to the bedsore statistics, it gets downright creepy.
 
When I first started reading the article, it looked sensible. Turn away people from the ER with silly, non-emergency issues or if they insist on staying, have them pay out-of-pocket for their hypochondria. A lot of what's mentioned past that, such as a doctor turning away a boy with a deep cut just because it wasn't bleeding profusely, seems downright abusive. By the time you get to the bedsore statistics, it gets downright creepy.

The laceration thing only seems abusive because its someone else's money, it might seem like a perfectly sensible solution if it was coming out of your own pocket. A cut, even a deep cut, that doesn't expose bone or threaten the patient's hemodynamic stability is not an emergency and can be repaired perfectly well in an outpatient setting. The difference in cost between doing it in an urgent care and in an ER is literally thousands of dollars. If you were paying for it, personally, would it be worth half a semester of that kid's college tuition to avoid a (maybe) 8 hour wait for treatment in an urgent care the following morning? If not, why is worth a semester of my (hospital employee/taxpayer) money?

The bedsore thing is more interesting, but it doesn't exactly sound like a systemic analysis of healthcare outcomes. As they pointed out, this chain owns hundreds of hospitals and they're focusing on bad outcome rates at 5 of them. Are the bedsores indicative of their overall outcomes? Does HCA hospitalls really have worse outcomes overall or is it just this one measurement? Also what is the amount of money we would need to dump into increasing staff to prevent one bad outcome? I feel like I would need a lot more data to make a judgement here.
 
the laceration thing only seems abusive because its someone else's money, it might seem like a perfectly sensible solution if it was coming out of your own pocket. A cut, even a deep cut, that doesn't expose bone or threaten the patient's hemodynamic stability is not an emergency and can be repaired perfectly well in an outpatient setting. The difference in cost between doing it in an urgent care and in an er is literally thousands of dollars. If you were paying for it, personally, would it be worth half a semester of that kid's college tuition to avoid a (maybe) 8 hour wait for treatment in an urgent care the following morning? If not, why is worth a semester of my (hospital employee/taxpayer) money?

The bedsore thing is more interesting, but it doesn't exactly sound like a systemic analysis of healthcare outcomes. As they pointed out, this chain owns hundreds of hospitals and they're focusing on bad outcome rates at 5 of them. Are the bedsores indicative of their overall outcomes? Does hca hospitalls really have worse outcomes overall or is it just this one measurement? Also what is the amount of money we would need to dump into increasing staff to prevent one bad outcome? I feel like i would need a lot more data to make a judgement here.

+1
 
Generally, the NYT positively salivates at any opportunity to shred physicians, hospitals, and our healthcare system in general. I am not refuting that the practices mentioned in the article exist, as they certainly do, and one might posit that there is greater motivation for such behavior at for profit hospitals (although realistically any hospital trying to survive in this climate would have such motivations, for profit or not), but as Perrotfish pointed out, this is hardly a thorough and comprehensive statistical analysis. Additionally, the phenomenon of "maximizing coding" occurs everywhere, regardless of whether a hospital is for-profit or not (including at just about every academic center, go ahead, ask your administration), to the point where there is an whole subindustry of accountants and analysts that contract out to hospitals whose entire job description consists of optimizing billing so hospitals get the most out of their efforts. It's not really all that much different from what every tax-paying American does come Tax Season...try to get the best return they can.
Again, I'm not condoning these specific events, merely trying to be realistic. It's very fashionable to hate on medicine right now, and scarcely a week goes by where the NYT doesn't cry foul and express self-righteous indignation at the "terrible atrocities" committed by doctors and hospitals. Tune in next week for the latest scandal...
 
The laceration thing only seems abusive because its someone else's money, it might seem like a perfectly sensible solution if it was coming out of your own pocket. A cut, even a deep cut, that doesn't expose bone or threaten the patient's hemodynamic stability is not an emergency and can be repaired perfectly well in an outpatient setting. The difference in cost between doing it in an urgent care and in an ER is literally thousands of dollars. If you were paying for it, personally, would it be worth half a semester of that kid's college tuition to avoid a (maybe) 8 hour wait for treatment in an urgent care the following morning? If not, why is worth a semester of my (hospital employee/taxpayer) money?

Don't deeper cuts become infected at a higher rate? If you start turning all these people away on a nationwide scale how many more cases of serious infection would there be thereby indirectly raising costs nationwide as a result?

Also, I'm actually not entirely sure why hospitals cannot be non-profit. All they would have to do is reinvest any profits back into the system which would thereby make itself better. I don't know if I am misunderstanding the concept though... Perhaps the profits keep them afloat because of outside investors.

However as others pointed out it is not surprising doctors are doing these types of things (unnecessary operations, rushing patients out of the hospital too early, etc) because I think a lot of them become numb to it all after a while. I have mixed feelings about incentives in the healthcare industry. For-profit would likely provide more efficient care but would it necessarily be better? It's hard to study because comparing a mostly government funded safety net hospital to a for-profit hospital is unfair since the patient populations are likely to be very different. But with my experience at safety net hospitals in some ways I find the approach to care to be superior (and I have rotated at for-profit hospitals). I think doctors after training gravitate toward for-profit stuff because their income is very significantly greater. This leads to a numbing of their emotions after a while and they are more likely to go along with policies that may perhaps not be in a patient's best interest.
 
"HCA says that more than 80 percent of its hospitals ranked among the top 10 percent in the country for federal quality measures, compared with 13 percent in 2006 when it went private. "

Sounds okay in my book. Every business has skeletons in their closet and any large hospital chain will have some examples of poor care. Focusing on a few examples is great and helps identify areas of potential improvement, but using them to judge a business seems short sighted, especially when the quality measures are more than up to snuff.
 
"HCA says that more than 80 percent of its hospitals ranked among the top 10 percent in the country for federal quality measures, compared with 13 percent in 2006 when it went private. "

Sounds okay in my book. Every business has skeletons in their closet and any large hospital chain will have some examples of poor care. Focusing on a few examples is great and helps identify areas of potential improvement, but using them to judge a business seems short sighted, especially when the quality measures are more than up to snuff.

:thumbup:
 
Also, I'm actually not entirely sure why hospitals cannot be non-profit. All they would have to do is reinvest any profits back into the system which would thereby make itself better. I don't know if I am misunderstanding the concept though... Perhaps the profits keep them afloat because of outside investors.

.

Many hospitals are non-profit. Those hospitals still want to bring in plenty of cash, so they can pay their executives excessive salaries:

http://www.freerepublic.com/focus/f-bloggers/2871169/posts
 
Seriously, you're linking freerepublic? Next up, we'll be using conservapedia as the source of unbiased truth...
 
Ah the myth of the "non-profit" hospital. These places tend to be the most aggressive in terms of business tactics, advertising, take-overs, etc. I have seen NPO hospitals deny hospital privileges to the established local family docs (the rare oldschool ones who actually see their patients) for political reasons (not scheduling in-house imaging, testing, etc), then hire their own in-house primary care physicians. There are all sorts of shenanigans going on. They grow like cancer. They jack up their bills, expand on the taxpayer's dime, hire tons of administrative overhead, pay CEOs millions, cry about all the losses incurred by accepting CMS and the uninsured, and the public continues to fall for it hook line and sinker.
 
Seriously, you're linking freerepublic? Next up, we'll be using conservapedia as the source of unbiased truth...


That's one of the first things that came up when I googled "Michelle Obama hospital job" (I was trying to verify that she previously worked at a nonprofit, I had a vague recollection when I googled it that she had a sweet gig at a hospital)
 
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Not sure whats going on at other hospitals. But a few points from an EM perspective:
Lac infection rates are determined by location and contamination. Not necessarily depth. Not all deep lacs need sutures. Mostly just ones that are open.
Two, repairing a laceration provides a lot of money. It counts as both a level 3 visit and a billqable procedure. If it doesnt need repair dont wast your time or the persons money. Just tell them to put bacitracin on it.
Third, my current job allows us to perform a medical screening exam. I love it. Saves time on dc although i still have to write them half up. Only really do it on silly stuff brought to the ER like a cerumen impaction or an insect sting to a pts little finger.
 
However as others pointed out it is not surprising doctors are doing these types of things (unnecessary operations, rushing patients out of the hospital too early, etc) because I think a lot of them become numb to it all after a while. I have mixed feelings about incentives in the healthcare industry. For-profit would likely provide more efficient care but would it necessarily be better? It's hard to study because comparing a mostly government funded safety net hospital to a for-profit hospital is unfair since the patient populations are likely to be very different. But with my experience at safety net hospitals in some ways I find the approach to care to be superior (and I have rotated at for-profit hospitals). I think doctors after training gravitate toward for-profit stuff because their income is very significantly greater. This leads to a numbing of their emotions after a while and they are more likely to go along with policies that may perhaps not be in a patient's best interest.

If docs/hospitals continue to get dinged on reimbursements/payments over issues that are not in their control then they will find ways to recoup their losses somehow.
If a DMer doesn't take their insulin, and their HgbA1c is not @ goal - Doc's at fault
CHFer gets readmitted within 30 days since they didn't take their meds, hospital at fault
The patients have NO incentive to be compliant & we get the brunt of the rod up the ***** when they do not comply.
Best thing for a PCP would be to just fire all non-compliant patients in order to secure their livelihood
 
Not surprised by some of the stuff listed in the article from NYT, some of the tactics listed by the hospital are reasonable in theory but can easily be taken over the line, such as correct billing to reflect the actual acuity of your patients.

Echoing the sentiment of the above comment: If we as hospitals and individual professionals are being held accountable for the services we provide, there needs to be a system in place to hold the patients accountable for their compliance to a healthcare regimen. Come to us for treatment and then remain non-compliant with your CHF meds? Sorry, but I am not at fault for your inability to weigh yourself daily, take a couple of pills, and avoid just some of the insanely salty food you have made an integral part of your diet.
 
I think you guys are misunderstanding what the hospital policy is there. The hospital is not turning away non-emergent care. The hospital is turning away non-emergent (free/uncompensated) care. ER's are required by law to evaluate and stabilize emergent cases. They are not required to do so for non-emergent cases. Unfortunately, patients often show up to the ER without insurance or if they have insurance, refuse to pay the required co-pay if they're billed for it after they have already left.

The laceration thing only seems abusive because its someone else's money, it might seem like a perfectly sensible solution if it was coming out of your own pocket. A cut, even a deep cut, that doesn't expose bone or threaten the patient's hemodynamic stability is not an emergency and can be repaired perfectly well in an outpatient setting. The difference in cost between doing it in an urgent care and in an ER is literally thousands of dollars. If you were paying for it, personally, would it be worth half a semester of that kid's college tuition to avoid a (maybe) 8 hour wait for treatment in an urgent care the following morning? If not, why is worth a semester of my (hospital employee/taxpayer) money?
 
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