HCA hospitals are now aggressively acticatjng

[Brigade4Radiant]

In Alleged Health Care ‘Money Grab,’ Nation’s Largest Hospital Chain Cashes In on Trauma Centers - KFF Health News

HCA charges patients an “activation fee” of up to $50,000 for trauma teams at centers located in half its 179 hospitals — and they often don’t need trauma care, an analysis of insurance claims data shows.

khn.org

It’s remarkable HCA stock has doubled in three years and the residencies they have will soon be calling code traumas on lacs to up their acuity.

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[southerndoc]

Saying that Mr. Knight didn't need a trauma activation because he only had a laceration requiring 30 sutures is the same as the insurance company saying someone didn't need an ER visit for their pleuritic chest pain.

The fact is that we don't determine trauma activations based on their end result. We determine them based on mechanism (level II) or physiologic (level I) criteria. The article probably left out the high probability that Mr. Knight could have been on a blood thinner, might have fallen >10 feet off the ladder, etc.

I do find the proliferation of HCA trauma centers to be concerning, and I question how this facility got Level I status. I'm assuming it was a state designation and not ACS verified. Failure to release their numbers is going against the requirements of entering their data into trauma registries, which makes their data public. ACS verification ensures there is no overtriage as well as undertriage. So the idea that a simple sprained ankle may be a trauma activation would be cited.

Georgia uses its super speeder ticket revenue to fund trauma activations. If a patient doesn't have the ability to pay, then Georgia has a fund that reimburses their trauma care. Maybe other states have something similar. Without that type of reimbursement system, I find it odd that HCA -- a for profit healthcare system -- would want to enter the trauma business, which has traditionally dealt with higher amounts of uninsured patients.

 

[erdoc00]

Saying that Mr. Knight didn't need a trauma activation because he only had a laceration requiring 30 sutures is the same as the insurance company saying someone didn't need an ER visit for their pleuritic chest pain.

The fact is that we don't determine trauma activations based on their end result. We determine them based on mechanism (level II) or physiologic (level I) criteria. The article probably left out the high probability that Mr. Knight could have been on a blood thinner, might have fallen >10 feet off the ladder, etc.

I do find the proliferation of HCA trauma centers to be concerning, and I question how this facility got Level I status. I'm assuming it was a state designation and not ACS verified. Failure to release their numbers is going against the requirements of entering their data into trauma registries, which makes their data public. ACS verification ensures there is no overtriage as well as undertriage. So the idea that a simple sprained ankle may be a trauma activation would be cited.

Georgia uses its super speeder ticket revenue to fund trauma activations. If a patient doesn't have the ability to pay, then Georgia has a fund that reimburses their trauma care. Maybe other states have something similar. Without that type of reimbursement system, I find it odd that HCA -- a for profit healthcare system -- would want to enter the trauma business, which has traditionally dealt with higher amounts of uninsured patients.

This is an indefensible practice and you, I, and everyone who works in an ER knows it.

It's the same reason free standing ERs were created.

After fleecing patients and their insurers by upcoding or "out of network"ing everything, these people shouldn't complain that what they were doing starts to get noticed.

For-profit healtchare shouldn't be allowed to exists exactly for this reason. This is outright greed and objectively fraudulent. And this is not capitalism which would be the argument that people could use for a pharmaceutical company or bioengineering company taking a risk to bring a product to market and then charging massive prices for their product. This is a hospital chain fraudulently labeling anything and everything it can as a "trauama" so that they can exploit the insurance system.

This should never have been allowed to exist in the first place. There is a huge difference between wanting to get justly compensated vs this flagrantly fraudulent scheme.

Although, many ER physicians are happy to cater to their masters so I expect many people to defend this just as they did for free standing ERs and for promoting nonsense low acuity ER visits "because they pay well."

Emergency medicine has become a joke of a specialty as a result of this crap. I hope everyone is happy with the piece of garbage we have created.

 

[RustedFox]

This is an indefensible practice and you, I, and everyone who works in an ER knows it.

It's the same reason free standing ERs were created.

After fleecing patients and their insurers by upcoding or "out of network"ing everything, these people shouldn't complain that what they were doing starts to get noticed.

For-profit healtchare shouldn't be allowed to exists exactly for this reason. This is outright greed and objectively fraudulent. And this is not capitalism which would be the argument that people could use for a pharmaceutical company or bioengineering company taking a risk to bring a product to market and then charging massive prices for their product. This is a hospital chain fraudulently labeling anything and everything it can as a "trauama" so that they can exploit the insurance system.

This should never have been allowed to exist in the first place. There is a huge difference between wanting to get justly compensated vs this flagrantly fraudulent scheme.

Although, many ER physicians are happy to cater to their masters so I expect many people to defend this just as they did for free standing ERs and for promoting nonsense low acuity ER visits "because they pay well."

Emergency medicine has become a joke of a specialty as a result of this crap. I hope everyone is happy with the piece of garbage we have created.

Though I agree with the sentiment; its not like it was we, the ER docs who "created this mess"; it was the MBAs and accountants B-schooltards and such.

Oh, and there are the BOOMERS who sold their groups to the CMGs. Eff those guys.

 

[Birdstrike]

Though I agree with the sentiment; its not like it was we, the ER docs who "created this mess"; it was the MBAs and accountants B-schooltards and such.

Oh, and there are the BOOMERS who sold their groups to the CMGs. Eff those guys.

As a non-Boomer (Gen-X), I have to defend Boomers a little bit on this. Although a few sold their SDGs to CMGs, many (if not most) of them just lost their contracts, were replaced and got little or nothing in return. Why would a CMG pay to buy an SDG, when they can simply undercut them and replace them without a fight? Once they've crippled an SDG, they can offer to buy out the non-competes and their doctors at a fraction of a price with little recourse.

SDGs by and large never came up with an effective way to prevent having their contracts terminated and quickly replaced. The grand plan of using non-competes didn't work and never had a chance of working, for SDGs that left themselves vulnerable to a sudden 100% drop of revenue due to contract loss.

SDGs were paper tigers all along. It's a miracle any of them lasted as long as they did, run by doctors with little to no business skill and even less corporate-killer instinct. We are where pharmacists-owners were 50 years ago; being replaced by corporate pharmacy chains. Just as mom-n-pop grocery stores aren't coming back to slay Walmart, I seriously doubt doc-owned SDGs are coming back to slay CMGs.

 

[EctopicFetus]

As a non-Boomer (Gen-X), I have to defend Boomers a little bit on this. Although a few sold their SDGs to CMGs, many (if not most) of them just lost their contracts, were replaced and got little or nothing in return. Why would a CMG pay to buy an SDG, when they can simply undercut them and replace them without a fight? Once they've crippled an SDG, they can offer to buy out the non-competes and their doctors at a fraction of a price with little recourse.

SDGs by and large never came up with an effective way to prevent having their contracts terminated and quickly replaced. The grand plan of using non-competes didn't work and never had a chance of working, for SDGs that left themselves vulnerable to a sudden 100% drop of revenue due to contract loss.

SDGs were paper tigers all along. It's a miracle any of them lasted as long as they did, run by doctors with little to no business skill and even less corporate-killer instinct. We are where pharmacists-owners were 50 years ago; being replaced by corporate pharmacy chains. Just as mom-n-pop grocery stores aren't coming back to slay Walmart, I seriously doubt doc-owned SDGs are coming back to slay CMGs.

In general this sentiment is right. However, there is a difference. The real issue we have today is we cant just open up an ED. We cant run hospitals, instead we are nothing but servants to our masters. EM docs didnt create this disaster the lawyers in congress did. As I said if EM was a stock I would be short selling it to the n-th. Everything is pointing to our “specialty” collapsing on the physician side.

 

[southerndoc]

This is an indefensible practice and you, I, and everyone who works in an ER knows it.

It's the same reason free standing ERs were created.

After fleecing patients and their insurers by upcoding or "out of network"ing everything, these people shouldn't complain that what they were doing starts to get noticed.

For-profit healtchare shouldn't be allowed to exists exactly for this reason. This is outright greed and objectively fraudulent. And this is not capitalism which would be the argument that people could use for a pharmaceutical company or bioengineering company taking a risk to bring a product to market and then charging massive prices for their product. This is a hospital chain fraudulently labeling anything and everything it can as a "trauama" so that they can exploit the insurance system.

This should never have been allowed to exist in the first place. There is a huge difference between wanting to get justly compensated vs this flagrantly fraudulent scheme.

Although, many ER physicians are happy to cater to their masters so I expect many people to defend this just as they did for free standing ERs and for promoting nonsense low acuity ER visits "because they pay well."

Emergency medicine has become a joke of a specialty as a result of this crap. I hope everyone is happy with the piece of garbage we have created.

It seems they are charging excessive fees, but the person quoted who fell off a ladder at an elderly age, it's not a stretch for that to be a trauma alert. 10 foot fall on a blood thinner has the potential to have some serious injuries. ACS verification ensures that facilities aren't overtriaging, so I'm hoping insurance companies soon require ACS verification before reimbursing trauma activations. Some states will let anything be a trauma center.

 

[RustedFox]

As a non-Boomer (Gen-X), I have to defend Boomers a little bit on this. Although a few sold their SDGs to CMGs, many (if not most) of them just lost their contracts, were replaced and got little or nothing in return. Why would a CMG pay to buy an SDG, when they can simply undercut them and replace them without a fight? Once they've crippled an SDG, they can offer to buy out the non-competes and their doctors at a fraction of a price with little recourse.

SDGs by and large never came up with an effective way to prevent having their contracts terminated and quickly replaced. The grand plan of using non-competes didn't work and never had a chance of working, for SDGs that left themselves vulnerable to a sudden 100% drop of revenue due to contract loss.

SDGs were paper tigers all along. It's a miracle any of them lasted as long as they did, run by doctors with little to no business skill and even less corporate-killer instinct. We are where pharmacists-owners were 50 years ago; being replaced by corporate pharmacy chains. Just as mom-n-pop grocery stores aren't coming back to slay Walmart, I seriously doubt doc-owned SDGs are coming back to slay CMGs.

I hear you.
It's BOOMERS all-around, though.
Boomer docs, boomer suits, boomer lawmakers.

 

[Birdstrike]

I hear you.
It's BOOMERS all-around, though.
Boomer docs, boomer suits, boomer lawmakers.

True dat.

 

[Birdstrike]

The real issue we have today is we cant just open up an ED. We cant run hospitals, instead we are nothing but servants to our masters. EM docs didnt create this disaster the lawyers in congress did.

Agree.

 

[MechEDoc]

SDGs were paper tigers all along. It's a miracle any of them lasted as long as they did, run by doctors with little to no business skill and even less corporate-killer instinct. We are where pharmacists-owners were 50 years ago; being replaced by corporate pharmacy chains. Just as mom-n-pop grocery stores aren't coming back to slay Walmart, I seriously doubt doc-owned SDGs are coming back to slay CMGs.

I suspect the best we can hope for are "benevolent" CMGs that operate on a co-op or Nucor Steel type management model. Perhaps even a franchise option would be ideal. Huge corporate backbone, consistency, capital, etc. local docs.

 

[turkeyjerky]

I suspect the best we can hope for are "benevolent" CMGs that operate on a co-op or Nucor Steel type management model. Perhaps even a franchise option would be ideal. Huge corporate backbone, consistency, capital, etc. local docs.

Isn’t this the CEP/Vituity model?

 

[MechEDoc]

Isn’t this the CEP/Vituity model?

Sort of I think. I have heard that Vituity is the best of the worst. I think there is plenty of room to improve.

 

[doctalaughs]

. Just as mom-n-pop grocery stores aren't coming back to slay Walmart, I seriously doubt doc-owned SDGs are coming back to slay CMGs.

The difference is that Amazon and Walmart are providing an objectively better product (cheaper, delivered instantly, easy returns, abundance of reviews etc etc).

On the other hand, due to distortions in our healthcare market CMGs are objectively providing a worse product (multiples of cost to patients) and take that profit for no gain to the end user.

I really think a law to say insurance must pay the same for each instance of XYZ service (regardless of location, practice or provider) would save our system.

 

[Birdstrike]

I really think a law to say insurance must pay the same for each instance of XYZ service (regardless of location, practice or provider) would save our system.

I agree that a law to eliminate the site-of-service differential would be hugely helpful. Of course there is tremendous resistance since it would hit hospitals in their pocketbooks. They've spent good money bribing politicians to get higher payments for identical services based solely on location. You and I wouldn't pay 5-6 times more for the identical car because it's located on one lot over another. Yet we routinely allow that, in healthcare to benefit corporate healthcare. It's insane.