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Whoops. NYT forgot this.
80% of HCA hospitals are in the top 10% in federal quality measures.
http://www.advisory.com/Daily-Briefi...-amid-downturn
A Giant Hospital Chain Is Blazing a Profit Trail
During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.
In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its compe ors.
The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.
HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.
Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.
As HCA’s profits and influence grew, strains arose with doctors and nurses over whether the chain’s pursuit of profit may have, at times, come at the expense of patient care.
HCA had put in place a flexible staffing system that allowed it to estimate the number of patients it would have each day in its hospitals and alter the number of nurses it needed accordingly.
Several nurses interviewed said they were concerned that the system sometimes had led to inadequate staffing in important areas like critical care. In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
‘Through the Roof’
Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not do enting whether ordered tests had been performed.
http://www.nytimes.com/2012/08/15/bu...gewanted=print
Whoops. NYT forgot this.
80% of HCA hospitals are in the top 10% in federal quality measures.
http://www.advisory.com/Daily-Briefi...-amid-downturn
lol ny timesIn response, HCA notes that more than 80% of its hospitals currently rank in the top 10% of U.S. hospitals based on federal quality measures. That represents a significant improvement from 2006, when just 13% of HCA hospitals were in the top 10%.
When private equity targets hospitals to pocket $10Bs sucked out of patients, you know it's way past time for a hard-core Medicare for all and VA (facilities, docs, nurses) expanded for all.
Scott history at Columbia Hospital Corporation
In April 1987, Scott made his first attempt to buy the Hospital Corporation of America (HCA). While still a partner at Johnson & Swanson, Scott formed the HCA Acquisition Company with two former executives of Republic Health Corporation, Charles Miller and Richard Ragsdale.[14] With financing from Citicorp conditional on acquisition of HCA,[15] the proposed holding company offered $3.85 billion for 80 million shares at $47 each, intending to assume an additional $1.2 billion in debt, for a total $5 billion deal.[16] However, HCA declined the offer, and the bid was withdrawn.[17]
In 1988, Scott and Richard Rainwater, a financier from Fort Worth, each put up $125,000 in working capital in their new company, Columbia Hospital Corporation,[18] and borrowed the remaining money needed to purchase two struggling hospitals in El Paso for $60 million.[19] Then they acquired a neighboring hospital and shut it down. Within a year, the remaining two were doing much better.[11] By the end of 1989, Columbia Hospital Corporation owned four hospitals with a total of 833 beds.[19]
In 1992, Columbia made a stock purchase of Basic American Medical, which owned eight hospitals, primarily in southwestern Florida. In September 1993, Columbia did another stock purchase, worth $3.4 billion, of Galen Healthcare, which had been spun off by Humana Inc. several months earlier.[20] At the time, Galen had approximately 90 hospitals. After the purchase, Galen stockholders had 82 percent of the stock in the combined company, with Scott still running the company.[19]
In 1994, Columbia purchased Scott's former acquisition target, HCA, which had approximately 100 hospitals. In 1995, Columbia purchased Healthtrust, which had approximately 80 hospitals, primarily in rural communities. By 1997, Columbia/HCA had become the world's largest health care provider with more than 340 hospitals, 130 surgery centers, and 550 home health locations in 38 states and two foreign countries. With annual revenues in excess of $23 billion, the company employed more than 285,000 people, making it the seventh largest U.S. employer and the twelfth largest employer worldwide. Based on market capitalization, Columbia ranked in the top 50 companies in America and top 100 worldwide. That same year, the company was recognized by Business Week magazine as one of the 50 Best Performing Companies of the S&P 500.[citation needed]
Columbia/HCA fraud case details
On March 19, 1997, investigators from the FBI, the Internal Revenue Service and the Department of Health and Human Services served search warrants at Columbia/HCA facilities in El Paso and on dozens of doctors with suspected ties to the company.[21] The Columbia/HCA board of directors pressured Scott to resign as Chairman and CEO following the inquiry.[22] He was paid $9.88 million in a settlement. He also left owning 10 million shares of stock worth over $350 million.[23][24][25] In 1999, Columbia/HCA changed its name back to HCA, Inc.
In settlements reached in 2000 and 2002, Columbia/HCA pled guilty to 14 felonies and agreed to a $600+ million fine in the largest fraud settlement in US history. Columbia/HCA admitted systematically overcharging the government by claiming marketing costs as reimbursable, by striking illegal deals with home care agencies, and by filing false data about use of hospital space. They also admitted fraudulently billing Medicare and other health programs by inflating the seriousness of diagnoses and to giving doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. They filed false cost reports, fraudulently billing Medicare for home health care workers, and paid kickbacks in the sale of home health agencies and to doctors to refer patients. In addition, they gave doctors "loans" never intending to be repaid, free rent, free office furniture, and free drugs from hospital pharmacies.[4][5][6][7][8]
In late 2002, HCA agreed to pay the U.S. government $631 million, plus interest, and pay $17.5 million to state Medicaid agencies, in addition to $250 million paid up to that point to resolve outstanding Medicare expense claims.[26] In all, civil law suits cost HCA more than $2 billion to settle, by far the largest fraud settlement in US history.[27]
http://en.wikipedia.org/wiki/Rick_Scott
Last edited by boutons_deux; 08-21-2012 at 01:57 PM.
Here's another equity group buying up nursing homes, in several countries, to get their hands that cash flow, while of course maintaining a highly cost effective "quality" of care
Blackstone Blamed for British Nursing Home Woes
The financial troubles of Southern Cross, Britain’s biggest nursing home operator, are causing problems for the Blackstone Group.
Blackstone, the American private equity firm, which owned Southern Cross five years ago, was accused Thursday by trade union representatives and some analysts of having at least contributed to the company’s dire situation.
Southern Cross, which houses more than 31,000 elderly people, said this week that it would have to defer 30 percent of its rent on its nursing homes for three months to stay in business.
Fear among residents’ families that the company would have to close some homes forced the British government to guarantee that residents would continue to receive care.
GMB, a campaigning trade union in Britain, called for a protest against Blackstone on Thursday in London, arguing that the private equity firm had been “instrumental” in Southern Cross’s financial troubles.
“This is the aftermath of their investment,” said Paul Maloney, who is a national officer for the union.
http://dealbook.nytimes.com/2011/06/...ing-home-woes/
80% of HCA hospitals are in the top 10% in federal quality measures.
When private equity targets hospitals to pocket $10Bs sucked out of patients, you know it's way past time for a hard-core Medicare for all and VA (facilities, docs, nurses) expanded for all.
I'm in agreement with a hard-core single payor model. But, using crappy data from compromised analysis does nothing to further the cause.
So what's more important here boutons? Quality of care improving, or just making sure that no one makes a buck along the way?
Well, there's the keyword "Bain". That's a bat-signal.
If equity capital is investing in health care, it's to make top returns, better than they can get elsewhere, for their investors out of the pockets of sick people.
You can be sure equity capital will continue hike up their prices well above inflation while reducing their services, when the country is trying to get the exorbitant World Champion High costs of health care down and provide care for all citizens.
Last edited by boutons_deux; 08-21-2012 at 03:12 PM.
Not an answer to the question I asked.
Quality of care went up. If someone made a buck along the way, so what?
top quality of care and no-profit are not mutually exclusive.
As we can see with the health care system, the priority is profits, not treatment outcomes.
Still not an answer to the question I asked.
As long as quality of care improves, why should it bother anyone if someone made a profit?
You and I need to dust it up over this.
Profit in and of itself is not an issue. However, framed within the context of continual healthcare cost escalation, the question becomes "How much profit?".
Nobody at DC is equipped to answer that rationally. Plus, it puts cost as the ultimate metric.
One thing profit performance can do, and was obliquely referred to in the NYT hit piece is, it can drive process efficiencies. Variablity is the enemy...a concept that needs to be applied to healthcare. Badly.
Profit is not the only driver for this however. A strong, centralized bureaucracy can drive standardization as well. In fact, it has an advantage that profit driven methodologies don't. Unified direction...or for lack of a better term, "vision".
,,,
"profit performance can do, and was obliquely referred to in the NYT hit piece is, it can drive process efficiencies"
health care should primarily be about OUTCOME efficiencies, not process.
BigPharma doesn't research most effective drugs, it researches the most profitable drugs, which often turn out to be maimers and killers.
We do need to dust it upYou and I need to dust it up over this.
Profit in and of itself is not an issue. However, framed within the context of continual healthcare cost escalation, the question becomes "How much profit?".
Nobody at DC is equipped to answer that rationally. Plus, it puts cost as the ultimate metric.
One thing profit performance can do, and was obliquely referred to in the NYT hit piece is, it can drive process efficiencies. Variablity is the enemy...a concept that needs to be applied to healthcare. Badly.
Profit is not the only driver for this however. A strong, centralized bureaucracy can drive standardization as well. In fact, it has an advantage that profit driven methodologies don't. Unified direction...or for lack of a better term, "vision"., but on another day. Fantasy football draft is tonight and thanks to Willard Gecko and Bain capital, I'm depending on my fantasy football team to provide me with much needed healthcare funding.
So here's a GFY to tide you over and I'll get back to this tomorrow.
We do need to dust it up
Outcome is all about the process, boutons. It is a huge driver in output.
It doesn't take a rocket scientist to know that with baby boomers aging and getting sicker, health care is a massive growth industry.
I read where much of the private equity is FOREIGN sovereign funds, so not even trickle down LIE can be touted, the profits in US sick people LEAVE THE COUNTRY.
I agree with you that profit in and of itself isn't an issue, but it sure looks like boutons thinks it is, which is what I was pressing him on. In this instance the answer to the question of "how much profit" was "more", and the end result of that was drastically improved quality of care without abnormal increases to costs (safe to assume since abnormal cost increases would have been perfect hit piece fodder, yet NYT made no such mention). Did rich people get richer in the process? Sure. Is that a problem? Depends what your priorities are here.You and I need to dust it up over this.
Profit in and of itself is not an issue. However, framed within the context of continual healthcare cost escalation, the question becomes "How much profit?".
Nobody at DC is equipped to answer anything rationally. (couldn't resist, i'm a cynic.Nobody at DC is equipped to answer that rationally.
Which is a good thing. I get why people want to go the warm fuzzy route and wish to use something other than cost as the ultimate metric, but going that route is exactly how you end up in the mess we currently find ourselves in. Whatever metric you try to put ahead of cost, an inability to control costs negatively affects your ability to achieve that metric.Plus, it puts cost as the ultimate metric.
A drive for standardization is not the same thing as a drive for process efficiencies. While I'll agree that a strong bureaucracy has the capability to provide a unified direction, it will fail miserably when it attempts to drive process efficiencies for the simple fact that it's own survival as an en y will never depend on it's ability to successfully find those efficiencies.One thing profit performance can do, and was obliquely referred to in the NYT hit piece is, it can drive process efficiencies. Variablity is the enemy...a concept that needs to be applied to healthcare. Badly.
Profit is not the only driver for this however. A strong, centralized bureaucracy can drive standardization as well. In fact, it has an advantage that profit driven methodologies don't. Unified direction...or for lack of a better term, "vision".
Last edited by coyotes_geek; 08-22-2012 at 09:17 AM.
Effectiveness should be the ultimate metric with costs being weighted, but, subservient to effectiveness. If we achieved enhanced effectiveness, as measured by outcomes, and even came close to current costs, it's a total win. Current spend is the target I would use. Price reduction is fool's gold.I agree with you that profit in and of itself isn't an issue, but it sure looks like boutons thinks it is, which is what I was pressing him on. In this instance the answer to the question of "how much profit" was "more", and the end result of that was drastically improved quality of care without abnormal increases to costs (safe to assume since abnormal cost increases would have been perfect hit piece fodder, yet NYT made no such mention). Did rich people get richer in the process? Sure. Is that a problem? Depends what your priorities are here.
Nobody at DC is equipped to answer anything rationally. (couldn't resist, i'm a cynic.
Which is a good thing. I get why people want to go the warm fuzzy route and wish to use something other than cost as the ultimate metric, but going that route is exactly how you end up in the mess we currently find ourselves in. Whatever metric you try to put ahead of cost, an inability to control costs negatively affects your ability to achieve that metric.
Variability is the enemy of process efficiency. Period. I agree that a bureaucracy does not fear the reaper in the same way a for profit model would. There has to be an accountability factor in this. I'm not smart enough to get there.
I do think the hybrid model I've been pitching is a good step forward as it combines the best of both models. Have a single payer handle routine HMO-type functions. Have for profit insurers provide, well, insurance (gasp!) as they were designed to do for issues outside of the (I know, heretofore undefined) "routine". Freed from the costs of HMO functions, insurance companies could produce reasonable premiums. Using the ACA administrative cost sledgehammer is a good tool to make sure these premiums are priced appropriately.
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