HCA leads campaign to curb doctor-owned hospitals

Before many of its heart surgeons left to become owners in a nearby specialty hospital, Oklahoma University Medical Center admitted 150 heart patients a month.

Soon after the doctor's hospital opened, OU's cardiovascular admissions fell to zero.

...

HCA, which runs 190 hospitals in the United States and overseas, has become one of the leaders in the campaign to curb expansion of physician-owned specialty hospitals across the country.

...

But proponents of the hospitals dismiss such arguments as self-serving.

''They bring competition to the community and bring a new way of thinking of health care,'' said Jim Grant, president of the American Surgical Hospital Association and a Nashville resident. ''They should be promoted.''


http://tennessean.com/local/archives/05/03/67207803.shtml?Element_ID=67207803



Suck it, Frist!

.... doctors owning hospitals, imaging centers and lab test facilities creates a conflict of interest that does not lead to good medicine.

Most hospitals suck but I doubt seriously that a doctor-run hospital is an overall benefit.

Mechanics should not own repair shops.

Does the Ownership Society the BFEE wants not pertain to doctors? Or shall they be worker bees like the rest of us?

Private practice has been around forever. How is this different?

Private hospitals are getting the cream of the crop in patients (those with decent medical insurance). The public hospitals are left with the dregs, and no means to pay for them. Doctor owned hospitals are thus hurting the taxpayers and creating an even worse two tiered medical system.

Aren't exactly "public."

which is happening in my hometown - and I think is of serious concern. This is a PRIVATE corporate hospital CHAIN (of which sen. maj Frist is associated - in some kind of ownership relationship - I believe) vs. local doctors creating their own PRIVATE facility.

Given Frist's stake in HCA - I say, lets watch the show evolve!

As the <http://www.consumerwatchdog.org/healthcare/nw/nw002987.php3|Chattanooga Free Press> put it in 98: "Sen. Frist's likely election to the majority leader post already is raising new questions about his ties to HCA. The chain was founded by his father and is now run by his brother, Thomas Frist."

current CEO is Dr. Frist, brother of Senator Bill Frist.

So, what's the difference?

The Frists started HCA to take care of people who have insurance.

Is a public hospital going to do a $50,000 open-heart surgery on a patient that has no way to pay for the procedure? Maybe one or two, and they write that shit off on their taxes.

A specialty hospital doesn't have an emergency room, which could (HUGE weasel word there) result in lower prices because even in the best-case condition (no indigents) trauma medicine is the most expensive practice. It probably won't--specialty hospitals are founded to treat very expensive conditions--but it could.

it is a corporate CHAIN who doesn't have to take medicaid patients, uninsured, etc.

ya lets start a pity party for HCA.

Public hospitals do get stuck with a disproportionate, if not all the bad pay/low pay heart surgeries. If the patient comes through the ER in an emergent condition, federal law requires treatment. Among the public hospitals, teaching hospitals are where the poor, homeless, out of work, or the working uninsured end up as the provider of last resort.

I've been a hospital administrator for 20 years, and I can assure you that any cost savings at the country club surgicenters are minimal. Simply put, if they are billing your insurance company, they are accepting a pre negotiated price, the same price the local hospital would receive. It is against law to have multiple fee schedules based on payor status.

As for "write that shit off on their taxes", public hospitals are 501(c)3 non-profits and don't pay taxes. But they do pay their bills.

"Simply put, if they are billing your insurance company, they are accepting a pre negotiated price, the same price the local hospital would receive. It is against law to have multiple fee schedules based on payor status."

That's not entirely accurate, either. True, it is against the law for an individual health care provider to have multiple fee shedules, but that just means that the initial bill that goes out of that facility has to be exactly the same for everyone that the provider bills. Beyond that, health care providers are allowed to negotiate the final rate.

Which means that any given hospital sends the initial bill for, say, $25k for a hysterectomy. They can allow Blue Cross to pay $3k total of the final bill; they can allow Aetna to pay $5k of the final bill, and can allow some small, no-name insurance company to pay $15k of the bill (and they smile, and say: but hey-- you're getting a full 12k off, that's a deal, man). A person off the street with no insurance is expected to pay the full 25k, so in comparison, I suppose it is a deal, in this sick and twisted world of health care.

But anyway, that particular hospital's initial bill, and their negotiated rates with various insurance carriers has nothing to do with what the local, public hospital's initial bill will look like. With chains such as HCA, the initial bill is very often much, much higher than the local public hospital's initial bill.

There is no rhyme or reason or legislative rationale behind the fee schedules, except that the initial pricing is set exorbitantly and yet consistently high, to accomplish two things: 1) satisfy the requirement that they bill everyone consistently. 2) make sure that the initial fee schedule is high enough to make sure they cover the high end of what some insurance companies are willing to pay. The hospitals would hate to find out that they set a hysterectomy charge at $25k and then find out some wacko carrier was willing to pay $26k.

The only thing capping prices is the flimsy legislative requirement that prices not be unreasonably exorbitant, which is a joke, because it's obviously unenforcable.

Dont' the doctor owned hospitals give them a little bit of price and service competition?

And isn't the existence of those hospitals already the reason that most uninsured people go to county hospitals?

... you could make that case. The difference is that consumers have a lot better chance of finding out what is really wrong with their car and getting it repaired appropriately than they do their bodies. Most folks don't have warranties on their cars, but trust me most car repair warranties don't let you take it to any mechanic and get anything you want done.

Most people don't wish to get a second or third opinion every time they see a doctor nor will their insurance cover it. The doctor can make any diagnosis he/she wants to and order any test that is remotely justified.

Back in the 70's, I went to a doctor for a time who ordered an in-house blood count and urinalysis NO MATTER WHAT YOUR COMPLAINT. It is absurd to think that is good medicine.

Doctors should order tests based on medical need, not on whether they own a piece of the MRI machine they are sending you to.

Actually, I don't favor restricting the ownership of anything by doctors. I just don't want a doctor-owned lab or imaging clinic to be able to profit in any way from a particular doctor's diagnosis.

At least when you take your car to a mechanic, you know he is going to make money on your repair and you can act accordingly. Most folks have no idea about the rampant conflict of interest in these diagnostic and treatment centers.

Had a cyst on my knee and an achilles tendon flare up.

Was ordered MRIs for both. 1k from me, 1k from Blue Cross. Doctor said, "yup, that's a cyst all right," and "yup, that's achilles tendon all right."

Another HCA doc wrote prescriptions for three additional medications I did not need and said as much when I went in for a sinus infection.

It is specifically because of these bloated bills that needlessly took cash from both my insurer and myself that I'm all for doctors owning their own shops, if they want to. With less overhead, less need to pad. And because they own it, they have that much more liability, which I would imagine they're fully aware of.

... that they can deliver these services cheaper than an outside source. In some cases, that might well be true. But I doubt if it's true a majority of the time, especially if the machines are located somewhere else.

There is no guarantee that physician-owned hospitals will reduce our medical bills, but there's no way in hell that leaving things the way they currently are will stop the spiraling costs.

The AMA is supportive of the physicians in this case, btw.

http://www.ama-assn.org/amednews/2004/12/27/bisb1227.htm

These speciality hospitals will exist regardless of whether they are doctor-owned or corporately owned. The corps don't want to have to compete against the worker bees.

... is that there are already a LOT of physician-owned imaging, lab, and other service centers. I don't have exact numbers, maybe I'll try to find them.

My point is that I find it hard to see how more of this is going to help.

They have to price their service so that can get other business.

And even if they order tests from their own comany, since they're vertically integrated, the cost of the test (which will be closer to actual cost) allows the doctor to price compete with their own services.

This isn't about the patient...it's about the bottom line and don't forget it.
You will not get better care, you will not see lower prices.
It is ultimately up to the insurance companies which hospitals will bend over the farthest as to where you will be "allowed" to go.
Very simple.

No matter how short staffed they are, they will NOT divert patients/ambulances to another hospital in our area. Forget that they don't have the nurses to staff the higher patient census, they just keep piling on the patients...they let people sit down in the ER for 12-13 hours sometimes before they can get them into a bed.
Ya see, Baylor Medical Center and Tenet have both opened new facilities near us and it is cutting into HCA's $$$. So there is no way in hell that they are going to give up one single patient. A bunch of our nurses have fled to other local facilities so that doesn't help the HCA staffing situation, either.
It's amazing to see 5, 6, 7 docs on a patient's case..yet they never go in actual room to visit with the patient or if they do it is for ONE minute and they are off!!!!! The docs just go read the nurses notes and write their little progress notes and collect their fee$.

...then a corporation.

don't want to have anything to do w/ the patients after their offices close. I cannot tell you how many MD's throw total hissy fits when they have to be called after hours about their patients..to a point where they will call the nursing supervisor and bitch about the floor nurses calling them about a change in patient condition or lab results, etc...we finally started writing one doctor up for his tirades and handing the info into the medical staff director and nursing administration. He then took all of his patients off of our floor and put them on a floor where the nurses put up w/ his abuse and just don't call him at night about patient problems. Crappy decision by those nurses, guess who loses their license when these same docs get sued and says "the nurse never notified me of a change in condition".

Bottom line, their oath taking doesn't always mean they actually care about their patients. Cardiologists and pulmonologists are the worst...at least at OUR facility. Heaven forbid they ever own a hospital, I sure as hell would not want to be a nurse in a facility where there is no one to turn to when these fools start getting abusive to the staff who are just trying to look out for the patients.

but unneccesary calls are the bain of my existence. I came back on call at seven o'clock this mornign, and had seven pages before seven thirty. Not one of them was neccesary. Perhaps the gate swings both ways, Nurse.

who is standing in front of you demanding that you call the MD. Put YOURself in the nurses' shoes. Tell the family NO and they tell nursing administration you would not call the MD...the nurse then gets her ass chewed out for not making the pt and family happy. And IF something does go wrong w/ that pt and it is on record that the nurse refused to call..there goes the nursing license. Agree to call the MD, get your ass chewed out by the MD for calling him or her after hours..the doctor then calls nursing administration because the nurse called. It is a no win situation for nurses. Personally, I choose the option where the doc calls the administration to complain about being called.

IMO, if a doc doesn't want a phone call about a pt after hours, go be a podiatrist or dermatologist. They want the buck$ of being another $pecialty that requires them to put pts in the hospital, then expect to be available 24/7 or get some grunt to take call for you.

Nurses are there to be a pt advocate, not a doctor advocate...if the pt needs something or their condition changes, expect a phone call, and expect the MD response to be put in my nursing notes...I've put MD comments in my notes before, in quotes, including, one time, the following: "MD states that nurse should not have called, when RN educated MD that RN needs to call for change in pt condition and that RN is accountable for this, MD denies RN is accountable for patient care".

My experience is that if the doctor is thoroughly explaining care, options and expectations, I don't need to call him after hours. It's only when I'm confused about what's going on that I have felt the need to speak to the doctor other than during routine rounds. I've had doctors watch TV in the hospital room while I'm trying to talk to them. Didn't leave me feeling very confident in the care my family members were getting.

What is trivial and mundane to you, may be of utmost importance to a patient and/or family.
You have no idea how many calls we try to avert for you.
You have no idea how many patients we try to pacify until a reasonable time in the morning.
You have no idea of how we try to stretch our imagination on a patient's existing prn medications to suit their new ailment to keep from having to call you.
When we have to call a Doc at night, we will ask everyone around if there is anything they need a doc for before we call to try to eliminate multiple calls and multiple wakeups for you.
But the thing is...if a patient and/or family demand we call the doctor--which they do--we have no choice but to call the doctor.
They have hired you to take care of them and most of them expect you to do so.
And just one thing, you said you had 7 calls before 7:30.
Would you have rather those night nurses called you all night or had the courtesy to wait til the next morning when you were awake as opposed to calling you in the middle of the night?
Those night nurses have a duty to clear their business before they leave--which is at 7:30--or face the wrath of the oncoming shift because they didn't do their work.

....biggest problems with health care have to do with how it is managed and not with how the labor part of it behaves?

buisness the work done is better.

Working in the medical field, I can assure you that just because a physican owns a clinic/hospital, that makes it better. Many docs are so greedy for money they make Enron/HCA/WorldCom look like saints.

There are many dedicated and professional doctors, and if you find one, hold onto him dearly.



And BTW - if my Mom had listened to her first cardiologist, she'd be dead by now. Fortunately, my Mom is very independent minded, got a second opinion, and had a double bypass to remove major blockage within a week.

services medical facilties debate on its head.

Round one (in the eighties nineties) public hospitals faced competition from CORPORATE hospitals - often with ownership of the corp hosp far away from the locality. The complaint was that the private could cream paying patients, by refusing to serve those without insurance, by not providing certain expensive services, etc.

now - round two with a twist...

Private Corporate (but closer to full service) CHAIN - face competition from... LOCAL doctor-owned (still for-profit) special care facilities. At least the newer trend - when pitted against the corporate chains - includes LOCAL folks with LOCAL concerns and keeping the $$ Local.

That, however, says nothing about the problem of round one type public hospitals vs private special care (doc owned) facilities (which is happening in my home town). In that case - it is local services (the full service - open to ALL of the public regardless of ability to pay) which are likely to be hurt due to the creaming referred to in round one.

Bull! The Doctors have the right to open a hospital!

ANYWHERE in medical care. Just try comparing the cost of aspirin at Walgreen's with what they charge you in a hospital.

This again turns the historical raison d'etre for 'capitalism' itself on its ear. In the Age of Monarchs, 'capitalists' argued for the private ownership of the means of production. They argued for the farmer owning his own farm. They argued for the blacksmith owning his own forge. They argued against an "ownership elite" (monarchs) who had entitlements to the labors of others (workers). "Robber Barons" don't want farmers to own their farms or blacksmiths to own their forges or doctors to own their own diagnostic tools. "Robber Barons" want all skilled workers to be enslaved by the "ownership elite." The only time it's acceptable for a worker to own the tools is when the worker stops working and drinks the Kool-Aid of the "ownership elite."

Is that I am all for the doctors owning there own place. The one issue i have is when they get multiple doctors involved. You see in the Diagnostic imaging field we have a big problem with doctor (non-radiologists) owned centers. Is what they do is they get about 50 or so doctors involved in one center. These 50 or so doctors then refer to the center that they have a vested interest. The problem with this is they are 1.7 times more likely to order an test that is not needed. It is just a pure case of "conflict of interests". They have done a study that when these doctor owned centers became more prevalent(last 3-4 years), the utilization of diagnostic imaging services went up 3 times it normal rate. It has cost the insurers and Medicare/Medicaid a boat load of money. You can read more about the ongoings here (http://www.auntminnie.com/index.asp?Sec=sup&Sub=imc&Pag=dis&ItemId=65757)

The Doctor run speciality hospitals cherry-pick the best patients, and leave the patients that are likely to default on bills to the General Hospitals. Most Hospitals rely on private insurance patients to make the money to support the Medicare/uninsured patients. Without these patients, the general care suffers.

burden of the uninsured.

That is why this is SO ironic. HCA - private facility - power to not serve medicare - power to not provide certain higher cost services (farm out) - dumping those on the local public (and often increasingly impoverished) hosptials.

At least the doctor owned speciality clinics would keep the profits local. Still not good for the public entities - but if we have to have HCA type corporate chains or local doc-owned specialty services - I take the latter anyday.

But can't imagine that good ole' Frist would sit idly by, with all his power, and not legislate some things that tip the scales towards the private corp hospital chains at teh expense of both public hospitals AND local doc owned speicialty clinics.

The private hospitals in my county are already complaining about caring for indigent..the North Central facility mentioned here is an HCA hospital. To be considered for the indigent program for medical care/reimbursment in this county, a individual has to make LESS than $2000/YEAR..yes, year..that is not a typo:

http://www.cwa-tseu.org/budgetnews_parkland.html

Gordon Broward had meager medical options when the pain in his lower back became too much to bear. The unemployed telecom manager had no medical insurance. He had no money to pay for a doctor visit. And there was no public hospital in Collin County that would readily accept him as a patient. So the 47-year-old Plano resident drove 20 miles south to the only public facility he knew, Parkland Memorial Hospital in Dallas


Private hospitals in Collin County are seeing more and more uninsured patients in their emergency rooms, complained several officials. "People are using our ER as a family practice doctor," said Sandra Fulce, director of business development and community relations at North Central Medical Center in McKinney. She estimated that her hospital spent $27 million last year caring for uninsured patients. "The private, for-profit hospitals pay a tremendous amount of taxes in this county," she said. "But we can't continue to absorb the burden of indigent care."

In its first year of operation, the free clinic subsisted mainly on donated drug samples, a $50,000 grant from county commissioners and a smattering of $10 donations from patients. With its patient load now exceeding 1,000 people, the clinic needs a permanent site and better cooperation with other health care providers in the county, Mr. Weis said. "The hospitals are not willing to take uninsured patients," he said. "In fact, they stabilize people in their emergency rooms and send them to us. I guess they have no other recourse."

<snip>

But Collin's indigent coverage only goes to the poorest residents – those whose incomes don't exceed 25 percent of the federal poverty level or $4,712 a year for a family of four.

HCA is a private corporation that runs hospitals. HCA merged with Columbia in 1994 and then proceeded to commit the biggest fraud on American healthcare in history.
They defrauded Medicare out of billions in the early 90's. An example: They would clip someones toenails and then bill Medicare for a leg amputation.
They were caught, fined, and then changed their name from the tainted name of Columbia back to HCA in an effort to confuse the people that didn't follow what happened.
The federal government also, as part of their settlement, makes employees of HCA do something that is called compliance testing.
It basically makes the employees watch a film, learn of the fraud that was committed, and instructs the employees to call a special number in the federal government if they see fraud occurring. You then have to sign papers stating you will do so or you will also be held accountable.
Their actions at that time forced Medicare to limit services to their patients to avoid this from happening again.
Where the patients with Medicare once had unlimited skilled days outside of the hospital, they now had a certain number. Where the patients once had unlimited physical/occupational therapy, they now had a certain number. The saying goes, as goes Medicare, so goes the private insurance industry.
It shook up Home Health to a high degree. Many patients who received Home Health benefits no longer had them. This was due to some unscrupulous agencies who were doing the same things that HCA was doing outside of the hospital.
HCA was also limited to a certain number of hospitals because of this fraud. They were forced to sell off many holdings, but interestingly, a new company from Nashville formed, a company called Tenet that purchased many of these holdings, and many speculated that it was a type of shadow company that was formed by HCA but as far as I know, the proof was never able to be obtained. Also of interest, another company that was also implicated in the fraud--Vencor Hospital--was also based out of Nashville. It received the same punishment as HCA, down to the compliance testing. It also reformed under the name of Kindred Healthcare.
Please don't ask me for links...I am not going to look this up. Just have been through the compliance testing several times so that is where I got my facts,lol, but am sure its out there somewhere if someone wishes to investigate.

edited to add link (one that is glossed over in favor of HCA, but all I could find)
http://www1.excite.com/home/careers/company_profile/0,15623,17,00.html

...that would keep them at the HCA facilities. Ie, they want more profit for capital and less profit for labor.

This is the same old story: labor getting the short end of the stick so that Wall St can get high rates of return on capital investment.

And you know what excuse that was given to new employees in my orientation at the HCA in-house nursing agency <about the fraud charges>?? "It was all because of a clerical error in the El Paso office". HAH! Right. Yeah, and about that oceanfront property in Arizona I'm selling you....

HCA opened up a nursing agency that is under the HCA umbrella <though they at first tried to distant themselves as being the owners of it>. Because the HCA hospitals couldn't/can't keep full time nurses, they opened this agency that would hire nurses who would work for a higher hourly rate but no benefits in hopes of not having to use "outside" agency nurses. It has gotten to a point where they have shut out all the other nursing agencies (in the towns that have this HCA in-house agency), refusing to use them. It's a very bizarre set-up...makes you wonder what kind of weird deals went on to get the whole "in-house" set up going.

But I worked an agency contract at Medical City in their peds for several months in 1999-2000.
They were hiring outside agency then. Then, they stripped it down to where they only used a handful of hand picked agencies--my agency was still in the pot.
At that point, they demanded that all agency nurses sign a type of contract that guaranteed servitude. The conditions of the servitude were insane. IF you were more than 15 minutes late, you had to pay a fine of $100 to Medical City. IF you were a no-show, you were responsible for another fine and I don't remember what the amount was, but it was egregious.
That was when I refused to go back and work there.
There wasn't any way I was signing anything that nonsensical.
I believe many of the agency nurses left at that point.
That was when they decided to have an in-house agency without benefits, that really amounted to nothing more than a PRN pool.
You are correct about one thing...they have a difficult time keeping full time nurses though,lol.

It is ironic for HCA to now be whining, as they have aggressivly acted solely in their best interests at the expense of public hospitals for years. On the other hand, competition in health care only serves to drive up costs. These private specialty hospitals skim off the best paying patients leaving the medicare/medicaid indigents behind. Without some good paying patients to offset the no pay/low pay, hospitals have to increase prices to everyone to make up the difference.

More importantly, the free market concept fails in health care. 1) The public is not able to accurately and effectively measure health care quality, so they cannot exert market influence with any real knowledge base, rather they choose by the sucess of marketing; 2) The urgent nature of much health care means that you do not have time to evaluate choices before treatment, you simply must receive care as soon as possible; 3)Emotion not reason inflences much decision making, need I say anything more than Terry S? 4) With doctors investing in their own hospitals, the chances of getting an objective referral from them is diminished, of course they want your good business in the new country club hospital, but your out of work brother in law can go to Inner City General. 5) Health care is so capital intensive that the industry is unable to respond to changes in the the market with any efficiency. 6) Many if not a majority of the public no longer have a choice even if they wanted to exercise it. Your "Choice" these days is to go where your insurance company tells you or endure a 50% copay or even no-pay.

In our town, half of the doctors on staff invested in a new surgery center. Guess who is left with the no pay business? the local public hospital.

Scroll down to the webpage's quote section, also...


http://www.polarisinstitute.org/corp_profiles/public_service_gats/corp_profile_ps_hca.html


Richard Rainwater and George W. Bush – Rainwater, one of the founders of Columbia HCA in the 1980s, is a friend and business associate of Bush’s, who, as reported by the New York Times, is one of the main reasons Bush was able to make millions of his past business investments. Rainwater played a major role in the investment of Bush into the Texas Rangers baseball team, which netted Bush more than $10 million upon its sale. In 1995, soon after meeting with Columbia HCA President Richard Scott, then Governor Bush vetoed a Texas patient protection bill. The bill, which Columbia HCA was very much against, would have expanded the number of children and adults covered by the state’s health insurance program for the poor. (“Midas Touch Was Billionaire’s Gift to Bush”, Barry Meier, New York Times, October 30th, 1999; Center for Public Integrity News Conference, January 2000)

Tennessee Senator Bill Frist and George W. Bush –Senator Frist, who has held enormous stock in HCA, disclosing that in 1994 $13 million of his personal wealth of $20 million was in HCA stock, was on the short list of potential choices by Bush to be his Vice-Presidential running mate (Dick Cheney was eventually chosen). Frist's father and brother founded Columbia HCA. He has been called the Republican point-man in the Senate on Health issues and opposes the proposed patients’ bill of rights. (“VP horse race hitting the final pole: Decision time approaching for GOP’s George W. Bush”, Ron Fournier and Douglas Kiker, The Telegraph Online (AP Story), July 22, 2000)

Department of Labor – joint program with HCA: HCA said it would train 1000 people to become nurses in their hospitals. The labor department decided to match this number with scholarships for training nurses who will later work for HCA. This is corporate welfare for a company that has been investigated and charged with defrauding the government and has been cutting wages greatly and gaining raised fees from the government for Medicare bills.
(The program was reported by Bovender at the UBS Warburg sponsored “Global Healthcare Services Conference”, a health care privatization conference held in New York, February 5th, 2002)

CEO Jack Bovender, on HCA’s relations with the Bush Administration: “very sanguine…based on the budget. a clear message it won’t be detrimental…Medicare rate increases will happen with this government.” (Bovender at the UBS Warburg sponsored “Global Healthcare Services Conference”, a health care privatization conference held in New York, February 5th, 2002)

Remember the whole Trent Lott thing?

Two days before Trent stepped down as Senate Majority Leader, HCA settled a huge ass government lawsuit over Medicaid/Medicare fraud.

http://www.cbsnews.com/stories/2002/12/18/national/main533453.shtml

Luckily, we were all too busy focusing on Lott's little slip of the tongue to notice this.

Guess this went under the radar <gee, what a surprise>..don't remember seeing it before.


http://www.consumeraffairs.com/news04/hca_suit.html


Health care giant HCA faces a class-action lawsuit over what it charges patients who have no health insurance. The plaintiffs in the suit claim the rates they were charged not only exceeded the industry norm, but in all cases were higher than those charged to insured patients.

The suit, filed in Clark County, Nevada, charges Mountainview Hospital, an HCA property, also initiated harassing and predatory collection efforts against the uninsured patients.


The plaintiffs are asking for restitution and attorneys' fees and they want HCA's profits from the alleged overcharging to go into a trust for the benefit of the plaintiff and other class-action members.

Billing issues are becoming more common in the health care industry, but hospitals generally defend their practice of providing discounts to insured patients, because of negotiated agreements with insurance companies. Uninsured patients charge that the practice is discriminatory. At least one hospital group has settled the action against it, agreeing to forgive $150 million in debt. With health care promising to be a major issue in an election year, Congress has even begun looking into the issue of higher rates for the uninsured.


http://subscript.bna.com/SAMPLES/hce.nsf/0/60d3400adbfeb4f185256e5c000351bc?OpenDocument



A health savings account insurer March 17 filed a federal antitrust lawsuit alleging that HCA Inc., two Florida acute-care hospital systems, and the Florida Hospital Association have conspired to fix prices that force uninsured and other patients to pay exorbitantly inflated rates for care (Medical Savings Insurance Co. v. HCA Inc., M.D. Fla., No. 2:04-CV-156-FTM-29-DNF, complaint filed 3/17/04).

Filed in U.S. District Court for the Middle District of Florida in Ft. Myers, the lawsuit by Medical Savings Insurance Co. also alleges the defendants have mounted a "coordinated and illegal group boycott" against the Indianapolis-based company for its refusal
to pay the prices.




edited for extra link

costs were due to greedy trial lawyers :shrug: :crazy:

Hospitals fell into four categories:

Public (municipal, state)
University
Religious
Doctor owned operated

Costs tended to go up as you went down the list, but doctor owned and operated hospitals have always been around. The doctor's hospitals were not that much different in cost, especially if you consider they were the only ones which received no subsidies. Most of the doctors made the bulk of their money though the fees for their services, not through hospital profits.

The new addition (sometime in the 1980s) to the list was the corporate for profit hospital that emerged primarily for the purpose of sucking peoples insurance dollars. This was lead by HCA, one of the first successful corporate hospital systems. They began by buying up distressed hospitals then cutting costs wherever they could (profits before quality and safety), began aggressively promoting services via advertising champaigns, cutting medical staff while adding to their legal staff and pressuring doctors to perform as many tests and procedures that they could possibly bill to the insurance companies.

Most of these hospitals also closed their emergency room services.

Most doctor owned hospitals simply wish to break even with the cost of running the hospital itself. The doctors will tend to make plenty of money being doctors rather than administrators, especially if their hospital builds a good reputation. Doctors want good equipment and adequate staff and they don't want excessive bureaucracy. The corporate hospital has no such incentive to quality care.

Here in Houston there are several HCA hospitals and my experience with them and those of people I know, is that they are the last place you want to be taken if you are ill.

HCA is the Frist family.