For patients or for profits?
reports on a series of scandals hitting for-profit health care giant HCA--and looks at how the quality of care patients receive has suffered, with sometimes deadly results.
IN THE last 20 years, as the health care crisis has accelerated and the number of uninsured has soared to over 50 million, publicly funded, not-for-profit hospitals have been transformed into ruthless, investor-owned, profit-generating businesses. Corporations have bought up not only hospitals, but dialysis clinics, outpatient surgical centers, home care agencies and physician practices with the singular goal of making money.
Hospitals are the nexus of profit-making for medical equipment and supply companies, the pharmaceutical industry, medical device makers, doctors who charge exorbitant fees and, increasingly, private investors. The health care sector has grown exponentially and now comprises one-sixth of the national economy.
No single company has been more successful in the hijacking of health care resources to Wall Street than the Hospital Corporation of America (HCA), which is currently facing a series of scandals. The industry giant's insatiable greed for profits has resulted in numerous, ongoing federal and state investigations and hefty fines.
Over the years, nurses and doctors at HCA facilities have consistently blown the whistle on unethical medical practices that have maimed and killed patients.
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HCA's TAGLINE on its website says, "Bettering the Human Condition." But HCA is better known for "bettering" the salaries and profits of shareholders and company executives. So far this year, HCA's revenues have increased 11.9 percent to $8.112 billion. In 2010, Richard Bracken, the CEO of HCA took home a compensation package that totaled a whopping $38.2 million.
HCA is the largest for-profit hospital chain in the United States and owns 163 hospitals and 110 surgical centers in 21 states.
The hospital chain, formerly known as Columbia/HCA, has a long, corrupt and criminal record. In the 1990s, it was investigated for Medicare billing fraud and accused of ordering unnecessary tests to boost revenue, having unethical relationships with doctors, and of the practice of "patient dumping."
In 1997, federal agents executed search warrants and seized documents related to billing practices at hospitals and clinics owned by Columbia/HCA. The company was fined $1.7 billion for Medicare fraud. At the time, Rep. Pete Stark (D-Calif.) commented, "Hopefully they'll all be in jail soon for the crimes they have committed across the country." No one went to jail.
Instead of being barred from participating in the Medicare program, the hospital chain was forced to sign a strict Corporate Integrity Agreement and their billing practices were monitored by an independent reviewer. That oversight ended in 2008.
History has a way of repeating itself. Soon after the oversight stopped, it was back to business as usual.
According to a recent New York Times investigation of HCA, "HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged."
The MBAs at HCA have worked overtime to get the company back to making superprofits by using methods developed by the founders of the company--Dr. Thomas Frist Jr., the former Republican senator from Tennessee, and Rick Scott, the current Republican governor of Florida.
Scott's business plan for health care delivery is based on how the fast-food industry delivers burgers and fries. He said, "The day has come when somebody has to do in the hospital business what McDonalds's has done in the fast-food business and what Wal-Mart has done in the retailing business."
An updated version of Scott's argument that health care should be run like an assembly line business is an article by Dr. Atul Gawande in the New Yorker. He argues that the restaurant chain The Cheesecake Factory is the new model for fixing the dysfunctional American health care system. He wrote: "We've let health care systems provide us with the equivalent of greasy-spoon fare at four-star prices, and the results have been ruinous. The Cheesecake Factory model represents our best prospect for change."
Gawande's argument is absurd; as if the human art and science of medicine and treating complex diseases like cancer and diabetes should adopt the methods that a restaurant chain uses to bake and serve 50 kinds of cheesecake. Treating health care like a factory commodity, while denying that care to millions, is the reason that the U.S. lags behind 19 advanced countries in preventable deaths.
We spend more than $8,000 per person for health care annually, and yet the quality of health care is worse in the U.S. than in nations that spend far less and provide coverage to everyone. It is the rapacious and destabilizing pursuit of profit in the privatized health care market that is the root cause of the fragmented and high cost of health care.
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HCA INCREASES profit margins in a contradictory combination of ways that are dangerous to patients' health. Recent scandals show that HCA medical providers have performed unnecessary medical procedures. In other instances, care is denied to the uninsured and rationed to the insured. Patients are discharged quickly and staff is cut to unsafe levels, particularly nurses.
A recent internal investigation by HCA--instigated after a nurse complained--found that HCA cardiologists have performed hundreds of unnecessary cardiac procedures, putting patients' lives at risk.
As the Times explained, "Cardiology is a lucrative business for HCA, and the profits from testing and performing heart surgeries played a critical role in the company's bottom line in recent years." Medicare reimbursement rates are $10,000 for a cardiac stent and $3,000 for a diagnostic cardiac catheterization--a lucrative figure for the company.
To jettison the uninsured, and avoid providing care that won't be reimbursed, HCA's emergency rooms refuse to treat patients who have "non-urgent" health conditions. The patients are told to go somewhere else for care--unless they pay an insurance co-pay or $150 in cash if they're uninsured, an impossibility for thousands of people.
Enormous pressure is put on medical staff to deny care and to dump uninsured patients to non-HCA hospitals. One uninsured patient went to an HCA emergency room in Nashville complaining of trouble breathing. The patient was discharged without care and was admitted to another hospital hours later with pneumonia. The New York Times reported that a Medicare investigation cited HCA for having "failed to ensure that an appropriate medical screening examination was conducted."
An article in 1996 in The Nation magazine interviewed nurses that worked for Columbia/HCA. They had a litany of complaints that included insufficient staff to assist patients in walking after surgery, delays of up to 45 minutes in delivering medication and other treatments and the elimination of overnight environmental cleaning services.
Sixteen years later history is repeating itself. HCA hospitals have one of the highest rates of bedsores, a preventable condition if there are enough nurses to turn patients over and check the skin. An HCA hospital in Florida was cited twice by regulators for having inadequate staffing levels to monitor bedsores. And, according to the New York Times, at least one patient has died due to untreated bedsores.
Research has shown that lower nurse-to-patient staffing ratios lead to improved health outcomes, increased hospital safety and decreased mortality. But what is good for patients is not always good for profits, and the Wall Street investors that own HCA hospitals have calculated that into the cost of doing business, putting patient's lives at risk.