The CMG name and shame thread for med students

[alpinism]

www.reddit.com/r/medicalschool/comments/11qlok1/finally_2023_name_and_shame_of_hca_florida_em

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[sloh]

Wow, TIL

So what does HCA do? The make it a trauma center and choose to set the absolute lowest bar possible to be considered a trauma patient. Guess who is the perfect target for Medicare fraud? Apparently is 65+ Medicare patients on Coumadin. There must be 10 of these a day, and while it should be taken seriously, it’s not worth the 20 ****ing grand they charge for the activation (by comparison it’s 5700 bucks at the county, I checked). It’s embarrassing as an emergency medicine doctor to have their totally manageable head injury patient fat fingered by trauma at a no name second rate hca hospital. And if that wasn’t enough, they included ALL head injuries as criteria regardless of a/c status. Do you have any idea how many old people fall and get a boo-boo? Thanks for the 20k I guess. They included “proximal long bone” injuries including hips and femurs. Like seriously a whole ****ing trauma activation for a hip or a ****ING HUMERUS. GET THE **** OUT OF HERE. Some of us tried to refuse this nonsense and were met with bullying from admin. HCA was blatantly committing fraud against Medicare recipients.

 

[RustedFox]

This is better than anything I've written on here.

 

[WorkNoteEmergency]

Dayum, I can’t possibly imagine what kind of head space I would be in if I felt like that at the end of residency with my whole career in front of me.

This kind of sentiment from residents gets around to the students and the ACGME needs to pay attention when they’re cleaning up the train wreck of these last two match years.

 

[Franzd'Epinay]

Dayum, I can’t possibly imagine what kind of head space I would be in if I felt like that at the end of residency with my whole career in front of me.

This kind of sentiment from residents gets around to the students and the ACGME needs to pay attention when they’re cleaning up the train wreck of these last two match years.

I'd be doing everything in my power to subspecialize.

 

[DocEspana]

HCA Florida West famously (at least among Floridians) was sued by two doctors, and subsequently massively find by CMS, for creating a payment system that essentially massively cut your salary if you did not admit most patients you interacted with. Basically setting up an RVU pool you basically competed against your co-workers for an active "pot" of money* and they calculated admissions as a "bonus" RVU on top of whatever the case itself was worth. Which is further complicated by the fact that many visits will be easier to justify a higher complexity if you admit the patient rather than discharge them - so some charts would be worth more as an admission than a discharge regardless of this bonus, but then also received a bonus.

This ended up with a system where if you didn't over admit, and inappropriately admit, you would basically end up with a de facto pay cut. Everyone else was admitting at high rates so you should too if you if you want to see any decent cut of the shared RVU pool. And when two doctors asked what they could do to raise their RVUs they were told that they need to admit more. They continued to complain about it and got fired. They sued HCA, which required HCA to open up the books, which let the federal government to see that they were basically paying emergency medicine attendings to admit inappropriately. CMS then demanded a massive amount of money back from HCA.

Mind you, basically nothing changed afterwards. But now they know that they can't openly admit that there is a bonus for admissions. But I know, even as a few years ago, they'll tell you to your face - they just won't put it in writing anywhere

* When I worked for HCA East they did the same thing with the pot of money, and they told you to your face that the best way to make more money is just to admit more people, but they were smart enough to not put it into writing how they expected you to work the system.

 

[TooMuchResearch]

So can anyone here do anything?
Know anyone in the ACGME or CMS?

 

[Pudortu]

In all honesty, after we reach a job equilibrium in a couple years, just stop hiring any HCA residency grad.

 

[EctopicFetus]

In all honesty, after we reach a job equilibrium in a couple years, just stop hiring any HCA residency grad.

Start now don’t hire people from these substandard places.

 

[forchinet121]

REPORT fraud and get paid millions for being a whistleblower!!!

 

[EctopicFetus]

REPORT fraud and get paid millions for being a whistleblower!!!

Need some proof etc. not as simple as it sounds.

 

[DocEspana]

REPORT fraud and get paid millions for being a whistleblower!!!

Believe you me if anyone ever put anything in writing, I would. But they never will. It's why those guys sued.

 

[DeadCactus]

"If you match at HCA the end is not over. Soaping into hca’s is much better than not matching at all."

And there you have everything wrong with medical education in this country.

 

[Brigade4Radiant]

HCA Florida West famously (at least among Floridians) was sued by two doctors, and subsequently massively find by CMS, for creating a payment system that essentially massively cut your salary if you did not admit most patients you interacted with. Basically setting up an RVU pool you basically competed against your co-workers for an active "pot" of money* and they calculated admissions as a "bonus" RVU on top of whatever the case itself was worth. Which is further complicated by the fact that many visits will be easier to justify a higher complexity if you admit the patient rather than discharge them - so some charts would be worth more as an admission than a discharge regardless of this bonus, but then also received a bonus.

This ended up with a system where if you didn't over admit, and inappropriately admit, you would basically end up with a de facto pay cut. Everyone else was admitting at high rates so you should too if you if you want to see any decent cut of the shared RVU pool. And when two doctors asked what they could do to raise their RVUs they were told that they need to admit more. They continued to complain about it and got fired. They sued HCA, which required HCA to open up the books, which let the federal government to see that they were basically paying emergency medicine attendings to admit inappropriately. CMS then demanded a massive amount of money back from HCA.

Mind you, basically nothing changed afterwards. But now they know that they can't openly admit that there is a bonus for admissions. But I know, even as a few years ago, they'll tell you to your face - they just won't put it in writing anywhere

* When I worked for HCA East they did the same thing with the pot of money, and they told you to your face that the best way to make more money is just to admit more people, but they were smart enough to not put it into writing how they expected you to work the system.

The lawsuit takes years and you are basically umeployable after suing them

 

[EDThoracotomy]

The best thing that could happen is these spots dont fill even after SOAP. Let them burn.

However, that's not going to happen because there is a massive influx of IMGs who will scoop those spots up.

 

[xaelia]

In all honesty, after we reach a job equilibrium in a couple years, just stop hiring any HCA residency grad.

I am loath to punish medical students who have done no wrong except try to become emergency physicians. Trying to say "go become a different kind of doctor rather than SOAP into HCA" seems a callous perspective from those who are comfortably on the other side.

The enemy is HCA, not the trainees. The tool we have to raise standards to prevent expansion and quash crap programs is the ACGME.

The borderline/actual fraudulent medical/billing practices is baked into our for-profit health system to varying levels of visibility, and not much we can do about that.

 

[KaiBuzz]

Just make a commitment to yourself that you will never work for a for-profit health system as an attending!

 

[EthylMethylMan]

"If you match at HCA the end is not over."

That's right, the end is not over. The end will continue for many years, until you get sued into oblivion from subpar training, or get replaced by Jenny, MSN, RN, APNP, GED.

 

[xaelia]

That's right, the end is not over. The end will continue for many years, until you get sued into oblivion from subpar training, or get replaced by Jenny, MSN, RN, APNP, GED.

Ahem, that's Dr. Jenny to you.

 

[RustedFox]

Just make a commitment to yourself that you will never work for a for-profit health system as an attending!

Lol.

 

[sloh]

Largest Healthcare Fraud Settlement Doesn’t Stop Behemoth

With the ever-growing healthcare fraud crisis that seems to plague the nation, HCA and its subsidiaries often find themselves in hot water.

whistleblowerjustice.net

Following their initial settlement fifteen years ago, the government structured the massive deal in such a way that would not bar the Hospital Corporation of America from Medicare, claiming that such a restriction would be comparable to a “corporate death sentence.” However, given the numerous and egregious schemes in which HCA has had involvement since 2002, the question begs to be asked: were they let off too easy? Clearly, HCA is a medical behemoth with no intention of restructuring their facilities in a way that would prevent fraud; even if such standards were put in place, it is hard to say whether it could hinder such activity solely because of the sheer size of the company itself.

 

[EctopicFetus]

Just make a commitment to yourself that you will never work for a for-profit health system as an attending!

That's right, the end is not over. The end will continue for many years, until you get sued into oblivion from subpar training, or get replaced by Jenny, MSN, RN, APNP, GED.

You forgot WAP, DTF

 

[JacobMcCandles]

Just make a commitment to yourself that you will never work for a for-profit health system as an attending!

There’s nothing more ‘for profit’ than a non-profit hospital.

 

[FlaminHotER]

I am loath to punish medical students who have done no wrong except try to become emergency physicians. Trying to say "go become a different kind of doctor rather than SOAP into HCA" seems a callous perspective from those who are comfortably on the other side.

The enemy is HCA, not the trainees. The tool we have to raise standards to prevent expansion and quash crap programs is the ACGME.

The borderline/actual fraudulent medical/billing practices is baked into our for-profit health system to varying levels of visibility, and not much we can do about that.

Add USUCKS, TH, Envsion, and whatever else alphabet parasite CMG to that list well!

 

[Kryptocoin]

I wonder if the HCA doctors have had their salary go up 140% in the past 5 yrs? Right....