By Peter Galuszka
Just on the heels of a blog posting praise for-profit HCA hospital company for “partnering” with doctors in Virginia to encourage “peer review” of best practices comes a devastating front page lead story in this morning’s New York Times.
It seems that HCA got into big trouble in Florida when doctors ordered excessive and risky cardiac work at several locations in Florida.
According to the Times, the doctors at hospitals north of Tampa and in the Miami area had a much higher rate of implanted “stents” to open clogged arteries than normal. The practice was flagged by a nurse whose contract was not renewed, but it touched off a large scale HCA internal probe.
One doctor, according to the Times, was labeled “EBITDA MD” in a hospital’s promotional material because he was “the most profitable doctor at the facility.” EBITDA is an accounting measure for net earnings.
Turning profit was important over the past decade for HCA, the largest hospital company in the U.S. In 2000, the firm agreed to a settlement and would be fined $1.7 billion in a Medicare fraud matter. In 2006, HCA was taken private by a group of investors led by Bain Capital (presidential candidate Mitt Romney was not involved). By 2010, the Times says, investors wanted to cash out of their investment and in a run-up to an initial public offering, HCA borrowed to pay $4.3 billion in dividends. In order for HCA to do that, it had to show continued, robust earnings and cardiology was a great department to find them.
About that time, a nurse at HCA’s Lawnwood Regional Medical Center in Ft. Pierce, reported the unusually high number of cardiac procedures that later could not be defended by “peer review.” The nurse founded his contract not renewed although HCA started probing. Federal prosecutors are now investigating. Patients were not told of the problem.
HCA owns some of the largest health facilities in the Richmond area, including Chippenham and Johnston-Willis hospital centers.
One wonders if there is a connection between the Florida debacle and HCA’s new-found interest in raising the standard of doctors. Also raised are questions about how the “free market” may or may not work with human health.
Although others on this blog grasp at solutions without doing the shoe leather journalism themselves, they only need to open the front page of the New York Times to see that the profit motives for a big, powerful corporation do not always translate into compassionate and efficient health care. It is also a lesson in why it is crucial to get beyond the initial press release.
