HCA's prescription for profits

Published Aug. 11, 2012

The nation's largest for-profit hospital chain is in trouble with regulators again. Florida hospitals in the HCA chain, including one in Pasco County, are under federal investigation in connection with concerns that cardiologists conducted unnecessary surgical tests and procedures. HCA allegedly boosted its billings by working with cardiologists who put profits before patient health and safety. After discovering the problem, hospital executives seemed more concerned with the bottom line than with patients, raising questions about HCA's ethics and its for-profit model.

As far back as 2003, there is evidence that questionable cardiology procedures have been performed in a number of Florida HCA hospitals such as the Regional Medical Center Bayonet Point, a 290-bed hospital in Pasco County, according to a review by the New York Times of internal documents, communications and other sources. The newspaper found that cardiologists at various hospitals, primarily in Florida, performed dangerous, unnecessary surgery that resulted in generous paydays for themselves and the hospitals.

In 2004, HCA did its own outside medical audit of Bayonet Point. It found that as many as 43 percent of 355 angioplasty cases were outside reasonable and expected medical practice. Worse still, some doctors justified the unnecessary procedures by misrepresenting the facts in medical records, claiming patients suffered blockages of 80 percent to 90 percent when they actually ranged from 33 percent to 53 percent, according to the findings. Bayonet Point ultimately suspended the privileges of nine physicians. Today, seven have regained their privileges and all nine are suing HCA for defamation.

HCA should have promptly turned the report over to regulators and contacted the affected patients to provide compensation. But it allegedly withheld the findings due to concerns about profitability, hiding behind confidentiality and peer review rules. Those privacy laws are supposed to protect the patient, not wrongdoing by a hospital or doctors. And the company refuses to say if it notified affected patients.

Mountains of money are at stake. HCA has more than 100 catheterization labs nationwide, and its Florida hospitals perform thousands of stent procedures annually. Medicare reimburses hospitals about $10,000 for a cardiac stent and about $3,000 for a diagnostic catheterization. The last time HCA was accused of defrauding Medicare — a period when Gov. Rick Scott served as the CEO — it paid $1.7 billion in fines. Scott denied any wrongdoing and left HCA years ago.

The hospital chain denies any wrongdoing now, as do the physicians accused of failing to follow proper medical standards. But the allegations suggest a disturbing pattern of endangering patients, and they again expose the weaknesses of a health care system driven by volume and profit rather than efficiencies and patient outcomes. The Justice Department's latest investigation of HCA should be aggressive and thorough.