Tuesday, August 14, 2012

The Strongest Possible Evidence Why the U. S. ‘Fee for Service’ Health Care System is Totally Broken

It Cannot Be Reformed – It Must Be Replaced

This forum has often commented on the fact that the rising health care costs and inefficiency in the health care system is the result of the basic structure of the system.  The United States has a largely private ‘fee for procedure’ system in which the doctors and health care facilities get paid when they perform procedures and do not get paid when they do not perform procedures.  Does it really take anyone with more than an 8th grade education to understand why this would lead to higher costs?

Now a report in the New York Times illustrates in very brutal terms just how bad the system is, and how it leads to billions in wasted money and unnecessary activity.

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.

Were lives put at risk?  Absolutely.

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.

And HCA has a nice long history of issues like this.

In 2000, the company reached one of a series of settlements involving a huge Medicare fraud case with the Justice Department that would eventually come to $1.7 billion in fines and repayments. The accusations, which primarily involved overbilling, occurred when Rick Scott, now the governor of Florida, was the company’s chief executive. He was removed from the post by the board and was never personally accused of wrongdoing.

And yes, just as you might expect Bain Capital (without Mitt Romney) plays a role.

In 2006, HCA was taken private by a group of private equityfirms, including Bain Capital, the firm co-founded by Mitt Romney, the presumptive Republican presidential nominee. (By that time, Mr. Romney was no longer a partner in Bain.) By mid-2010, the private equity owners were eager to start cashing out of their investment. While HCA prepared for an initial public offering of its stock that took place in 2011, it borrowed to pay the private equity firms $4.3 billion in dividends.

To its credit HCA uncovered a lot of the problems in an internal investigation.

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 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.

And the former nurse, well he got exactly what everyone would think he deserved.

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

What, you expected a different outcome! 

1 comment:

  1. It Cannot Be Reformed – It Must Be Replaced. I agree. Thanks for sharing. :)