Mt. Vernon Register-News

January 8, 2013

No Longer Surprised!


CNHI

MT. VERNON — Before I start on this column I have a question for you. How many of our elected members of Congress and appointed government officials will be affected by the so called “falling off the fiscal cliff?”

It would probably be interesting to know. They have a history of making many decisions that are not in our best interest that have absolutely no effect on them personally.

Now, I want to talk about a subject that you hear every day from politicians. How many times a day, week or month do you hear that a major reason we spend more than we take in is the result of over-generous entitlements? I cannot describe in this paper without getting slapped for bad words by my editor how I hate the word “entitlements.”

I watched a program on 60 Minutes that I found almost unbelievable and frankly very sickening. The program described  how a for-profit company had purchased a group of hospitals and was allegedly setting goals for how many admissions should result from emergency room visits, how many tests should be run, etc.

They had accusations from reportedly more than 100 of its current and former employees that the company pressured its doctors to admit patients “regardless of medical needs” to boost company profits. Do you think practices like this have anything to do with us having the highest medical cost sof any developed country? The owner is reported to own 70 hospitals in 15 states.

“On camera, some of the company’s former employees including doctors that formerly worked for HMA shared the same story, saying there were admission targets and software that coerced HMA doctors into admitting more patients. They accused the company of fraud and said doctors who didn’t meet quotas faced threats they would be fired.”

The thought of going to an emergency room that where the goal is to admit to the hospital 20 percent of all patients and 50 percent of those over 65 years of age should cause all of us to question. Is this one of the reasons that medical cost is the major issue of today? If these practices are part of the reason the cost of Medicare and Medicaid is so out of control, shame on us for allowing and condoning it.

In the 60 Minutes segment, Steve Kroft, a 60 Minutes journalist, showed Allan Levine, a senior vice-president for HMA, a physician performance review from an HMA hospital in Durant, Okla., that included an admission goal of 20 percent. The report was apparently a score card measuring individual doctors against the goal. Below is an excerpt from Naples News by Laura Layden:

“Cliff Cloonan, the former assistant emergency room director at the Carlisle Regional Medical Center, an HMA hospital in Pennsylvania, and Scott Rankin, another doctor who worked for the same department, said they were told they would “lose their jobs” if they didn’t start admitting more patients.

“My department chief said, ‘we will admit 20 percent of our patients or somebody’s going to get fired,’”Cloonan said. “There’s no way you can do that and not have it be fraudulent because you’re not admitting on the basis of medical requirements, you’re basing it on strictly an arbitrary number that has been pulled out.”

For patients who were 65 and older, Rankin said the admission goal was 50 percent. Those would be Medicare patients, he said.

You tell me how practices like this and reports of $750 billion reported in waste and fraud are never mentioned when we hear the cry to cut Medicare benefits to seniors by our politicians? Can you believe that problems like these voiced by former doctors and others with e-mails and documents about the setting of goals to admit patients should not be the number one focus of our political leaders before considering any cuts to Medicare or Medicaid?

“A retired 30 year veteran of the FBI, working as a compliance officer for HMA reportedly told the upper management that Medicare was being fraudulently billed,” the report states. “Paul Meyer, who raised the issue of inappropriate admissions a few years ago while still working as the company’s director of compliance, also talked to Steve Kroft. Meyer was a 30-year veteran of the FBI, who supervised Medicare fraud in Miami before joining HMA. He alleges HMA intentionally billed Medicare and Medicaid for unnecessary hospital stays, to the tune of hundreds of thousands of dollars. He’s now suing HMA for wrongful termination.”

We now are getting reports that the buying of doctor’s medical practices by hospitals could be a prime driver of the horrendous increase in health care cost over the last decade. A recent article about “Hospitals at War” by Reese Albeson, really brings into perspective the bind that doctor’s are placed in as these hospitals push for higher profits. It is a story about two hospitals in Boise, Iowa, which started buying up medical practices and the effects on the quality and cost of health care. There is not room for a detailed explanation in one column so I will just hit the high points and maybe do a little more on this subject in the future.

I have said many times how blessed I have been with the doctors who cared for me in Mt. Vernon. My first experience here, my doctor told me that if I did not want to pay attention to his recommendations that I should not waste his time. I stayed with him until he retired several years later. His replacement told me that I might live for a long time, but the quality of life would not be good if I did not quit smoking. I quit many years ago because of his honesty. My doctor who repaired my shoulder told me that full rehabilitation would take six months. I thought it could be done in three months. It took six months. I would recommend this surgeon to anyone. My doctor who took me through cancer told me that I would have to take the powerful medications from February to November and stop whining. He said a puppy stops whining at 6 to 8 weeks. I did and that was six years ago, thanks to his care.

I only bring this up because I have reached a conclusion that the problem is probably not so much with the doctors. The major problem is with the hospitals and insurance companies. I am not naïve enough to believe that some of the waste and fraud is not attributable to some unscrupulous doctors, but the more I read about the pressure they are put under by bonus driven managers in hospitals and insurance giants the more I believe their role is not so large.

I am going to close this column with a couple of excerpts from this article about the “Hospital War” in Boise, Iowa, and plan to write more on this subject.

 “We’re seeing a lot more consolidation than we did 10 years ago,” said Jeffrey Perry, an assistant director in the FTC.’s Bureau of Competition. “Historically, what we’ve seen with the consolidation in the health care industry is that prices go up, but quality does not improve.

“Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay.”

I will write on this subject in coming weeks of the two warring hospitals in Boise.