Nashville, Tenn.-based Hospital Corporation of America is the topic of another exposé from the New York Times. The newspaper analyzed HCA's business model — specifically, the relationship between quality of care and booming profits — after it honed in on the for-profit chain's cardiac procedures last week.
A significant portion of the article focuses on HCA's emergency departments. In 2006, slightly more than 25 percent of HCA's Medicare payments were for patients in the two highest-paying reimbursement categories. Other hospitals billed 58 percent of their patients at those high-paying levels, according to the NY Times.
This changed in late 2008 when HCA's corporate integrity agreement — part of its Medicare fraud settlement — was coming to an end. HCA introduced a new coding system it said was based on a method developed by the American College of Emergency Physicians. By 2010, 76 percent of HCA's payments came from the two highest-paying reimbursement codes compared with 74 percent for other hospitals.
The increase made a significant difference at independent hospitals. For instance, Medicare reimbursements surged from $48,000 in 2006 to $949,000 in 2010 at Riverside (Calif.) Community Hospital, according to the report.
In a statement released in anticipation of the NY Times article, HCA said, "We implemented this system, which is used by many hospitals, because it provides for greater consistency and simplicity than the point system HCA had previously used. … After several years of using this model, we believe our classifications are generally consistent with national averages."
HCA hospitals were also among the first to impose protocols to lessen the volume of ED patients by telling patients with nonurgent symptoms to go elsewhere for care or offer treatment if they paid the co-payment.
Physicians in the NY Times report claim HCA established "targets" for how many patients they needed to turn away and treat. The NY Times obtained an email sent from an outside company that worked in the ED of an HCA hospital to the ED physicians. The email told physicians that HCA regional executives held expectations that "approximately 15 percent of all patients are to be screened and of those screened no more than 35 percent overridden."
HCA officials said the company instituted the processes to reduce ED overcrowding, and they denied the establishment of quotas, according to the report. HCA said in its statement, "Many ERs in America have adopted a variety of systems to determine whether a patient in fact needs emergency care. About half of HCA-affiliated hospitals have done so, and they typically have two caregivers, usually a triage nurse and a physician, make that determination."
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A significant portion of the article focuses on HCA's emergency departments. In 2006, slightly more than 25 percent of HCA's Medicare payments were for patients in the two highest-paying reimbursement categories. Other hospitals billed 58 percent of their patients at those high-paying levels, according to the NY Times.
This changed in late 2008 when HCA's corporate integrity agreement — part of its Medicare fraud settlement — was coming to an end. HCA introduced a new coding system it said was based on a method developed by the American College of Emergency Physicians. By 2010, 76 percent of HCA's payments came from the two highest-paying reimbursement codes compared with 74 percent for other hospitals.
The increase made a significant difference at independent hospitals. For instance, Medicare reimbursements surged from $48,000 in 2006 to $949,000 in 2010 at Riverside (Calif.) Community Hospital, according to the report.
In a statement released in anticipation of the NY Times article, HCA said, "We implemented this system, which is used by many hospitals, because it provides for greater consistency and simplicity than the point system HCA had previously used. … After several years of using this model, we believe our classifications are generally consistent with national averages."
HCA hospitals were also among the first to impose protocols to lessen the volume of ED patients by telling patients with nonurgent symptoms to go elsewhere for care or offer treatment if they paid the co-payment.
Physicians in the NY Times report claim HCA established "targets" for how many patients they needed to turn away and treat. The NY Times obtained an email sent from an outside company that worked in the ED of an HCA hospital to the ED physicians. The email told physicians that HCA regional executives held expectations that "approximately 15 percent of all patients are to be screened and of those screened no more than 35 percent overridden."
HCA officials said the company instituted the processes to reduce ED overcrowding, and they denied the establishment of quotas, according to the report. HCA said in its statement, "Many ERs in America have adopted a variety of systems to determine whether a patient in fact needs emergency care. About half of HCA-affiliated hospitals have done so, and they typically have two caregivers, usually a triage nurse and a physician, make that determination."
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