For-profit hospitals performed unnecessary heart

[ttt]

:-| :-|

www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?hp

In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company’s hospitals in Florida.

In a follow-up interview, the nurse said a doctor at the Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.

“It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview. “I’m a registered nurse. I care about my patients.”

In less than two months, an internal investigation by HCA concluded the nurse was right.

“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.

Mr. Tomlinson’s contract was not renewed, a move that Mr. Johnson said in the memo was in retaliation for his complaints.

But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.

HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.

Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.

At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages.

At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.

In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports.

On Monday morning, in a conference call with investors, company executives disclosed that in July the civil division of the United States attorney’s office in Miami requested information on reviews assessing the medical necessity of interventional cardiology services provided at 10 of its hospitals, located largely in Florida, but also two or three hospitals in other states. In the conference call and in a statement on its Web site, the company also referred to inquiries by The Times. HCA’s stock ended nearly 4 percent lower Monday, at $25.55.

In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law.

“When the company becomes aware of a situation in which we might have a reimbursement obligation, we assess, with outside resources, what our reimbursement obligations might be,” the statement said.

HCA also declined to show that it had ever notified patients, who might have been entitled to compensation from the hospital for any harm.

Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals.

The cardiologists say the reviews of their work did not accurately reflect the care they provided, and HCA says the reviews “are not, by any means, definitive,” according to an e-mailed response by the company. HCA says it took whatever steps were necessary to improve patient care. It also said “significant actions were taken to investigate areas of concern, to bring in independent reviewers, and to take action where necessary.”

Details about the procedures and the company’s knowledge of them are contained in thousands of pages of confidential memos, e-mail correspondence among executives, transcripts from hearings and reports from outside consultants examined by The Times, as well as interviews with doctors and others. A review of those communications reveals that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line.

HCA denies its decisions at these hospitals were motivated by financial considerations, but rather “demonstrate the strong focus we have on quality patient care.” The company also says that more than 80 percent of its hospitals are in the top 10 percent of government rankings for quality.

Although HCA has hospitals in about 20 states from California to Virginia and Alaska to Texas, Florida, with its large older population, is a critical and growing market for hospital chains and especially for HCA. HCA’s Florida hospitals provide about 20 percent of the company’s revenue.

(more at link)

[mcgee]

Pick up a copy of "Overtreated" by Shannon Brownlee.

www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791/ref=sr_1_1?ie=UTF8&qid=1344306170&sr=8-1&keywords=overtreated+why+too+much+medicine+is+making+us+sicker+and+poorer

This sort of thing is far more common than you'd think.

[Deleted]

This is all going to point back to Rick Scott. Mark my words.

[copzgirl1171]

On a much smaller scale this is part of the reason I left the medical field years ago.

Kudo's to this nurse for speaking out.

[MrsDL]

Aug 6, 2012 21:23:20 GMT -5 mcgee said:

Pick up a copy of "Overtreated" by Shannon Brownlee.

www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791/ref=sr_1_1?ie=UTF8&qid=1344306170&sr=8-1&keywords=overtreated+why+too+much+medicine+is+making+us+sicker+and+poorer

This sort of thing is far more common than you'd think.

Yeah - we had two cases at two different not-for-profit hospitals in MD over the last few years. It was all over the news. Both docs lost their licenses - both cases were whistle blower cases. In one case, because the doc was being sued out the ass and hadn't had his hearing about his license, he sued his own physcian who peformed Lasik surgery stating he was putting stents into patients with like, 20 or 30% occlusion because he could see correctly? WTF. He tried to say he was randomly inserting stents into peoples' coronaries because he couldn't see? It was crazy.

[copzgirl1171]

It happens daily on a smaller scale that doesn't get the press that larger cases get.

Take an elderly patient on Medicare with a good paying secondary insurance who say has diabetes and high blood pressure but is otherwise in good health. Doctors will get them on an every other month rotation to come in and have an office visit, blood draw, and ekg before they will give them their prescriptions.

Many doctors hold a patients prescriptions hostage basically as a way of getting them to come back to the office on the routine. It's sickening.

[ttt]

This is why "for profit" and "medicine" should never go together.

[One Girl In All The World]

Aug 7, 2012 13:03:29 GMT -5 ttt said:

This is why "for profit" and "medicine" should never go together.

Best healthcare system in the world!

:-|

[Deleted]

Aug 7, 2012 13:03:29 GMT -5 ttt said:

This is why "for profit" and "medicine" should never go together.

I've worked in both for-profit and not-for-profit hospitals, and honestly, this same abuse occurs equally in both because the profit status doesn't affect whether or not the cardiologist gets paid.

On a side note - I could be wrong on this, but aren't NFP hospitals exempt from taxes? Personally I'm OK with hospitals paying taxes so if they means being FP, then that's fine.

[Michelle]

Aug 7, 2012 14:53:31 GMT -5 sunmoonstars said:

Aug 7, 2012 13:03:29 GMT -5 ttt said:

This is why "for profit" and "medicine" should never go together.

I've worked in both for-profit and not-for-profit hospitals, and honestly, this same abuse occurs equally in both because the profit status doesn't affect whether or not the cardiologist gets paid.

On a side note - I could be wrong on this, but aren't NFP hospitals exempt from taxes? Personally I'm OK with hospitals paying taxes so if they means being FP, then that's fine.

Yes, we're exempt from taxes (I work for a NP health system). But in order to qualify for that status one has to do a LOT for community healthcare needs (like give millions to clinics, charity care centers, etc.)

One of the nice things about being NP is you don't have to struggle between doing the right thing and making shareholders happy. You do have to make board members happy but that is more about showing responsible management of the company. It is much easier to be a great employer and focus on the highest quality of safety and care for patients at the same time when you don't have shareholder interests to balance too.

[MrsAxilla]

Aug 7, 2012 14:53:31 GMT -5 sunmoonstars said:

Aug 7, 2012 13:03:29 GMT -5 ttt said:

This is why "for profit" and "medicine" should never go together.

I've worked in both for-profit and not-for-profit hospitals, and honestly, this same abuse occurs equally in both because the profit status doesn't affect whether or not the cardiologist gets paid.

It's really the fee for service model that's the problem, not the tax status.

[Deleted]

Aug 7, 2012 15:11:21 GMT -5 MrsAxilla said:

Aug 7, 2012 14:53:31 GMT -5 sunmoonstars said:

I've worked in both for-profit and not-for-profit hospitals, and honestly, this same abuse occurs equally in both because the profit status doesn't affect whether or not the cardiologist gets paid.

It's really the fee for service model that's the problem, not the tax status.

Both FP and NFP operate on the fee-for service model.

And again, it makes no difference to the doctors if the hospital is FP or NFP, because the hospital isn't paying them. Profit status does not determine what procedures get done.

[MrsAxilla]

Aug 7, 2012 15:51:53 GMT -5 sunmoonstars said:

Aug 7, 2012 15:11:21 GMT -5 MrsAxilla said:

It's really the fee for service model that's the problem, not the tax status.

Both FP and NFP operate on the fee-for service model.

And again, it makes no difference to the doctors if the hospital is FP or NFP, because the hospital isn't paying them. Profit status does not determine what procedures get done.

Yes, that was my point.

[Deleted]

I would think its both the fee-for-service and the for-profit thing that would impact that.

I know there are caps here as to what a doctor can be paid, so that eventually a doc wouldn't have any incentive to do something like that.

Really though, what a douchey move. I mean, I trust my doctor with my life, literally. To think one might do something like that is horrendous.

[Deleted]

Aug 7, 2012 15:06:10 GMT -5 Michelle said:

Aug 7, 2012 14:53:31 GMT -5 sunmoonstars said:

I've worked in both for-profit and not-for-profit hospitals, and honestly, this same abuse occurs equally in both because the profit status doesn't affect whether or not the cardiologist gets paid.

On a side note - I could be wrong on this, but aren't NFP hospitals exempt from taxes? Personally I'm OK with hospitals paying taxes so if they means being FP, then that's fine.

Yes, we're exempt from taxes (I work for a NP health system). But in order to qualify for that status one has to do a LOT for community healthcare needs (like give millions to clinics, charity care centers, etc.)

Except for religious hospital systems; they automatically qualify for tax-exempt status.

[One Girl In All The World]

Aug 7, 2012 14:58:40 GMT -5 asdfjkl said:

Color me shocked* that this was HCA.

*I'm not really shocked.

:Y:

[Michelle]

Aug 7, 2012 17:31:28 GMT -5 sunmoonstars said:

Aug 7, 2012 15:06:10 GMT -5 Michelle said:

Yes, we're exempt from taxes (I work for a NP health system). But in order to qualify for that status one has to do a LOT for community healthcare needs (like give millions to clinics, charity care centers, etc.)

Except for religious hospital systems; they automatically qualify for tax-exempt status.

I don't think that is necessarily true. Otherwise why would the religious hospital systems still have to file 990s and get audited by the IRS based on the contents on those 990s?

But i'm not a tax specialist by a long shot.