A report from the nation’s largest nurses union accuses HCA Healthcare of over admitting emergency room patients into its hospitals to increase profits.
The report from the Service Employees International Union analyzed national Medicare data and found that hospitals run by HCA had an emergency department admission rate in 2019 that was 5% higher than the national average. In Florida, HCA’s emergency room admission rate in 2019 was 41%, compared to 38% for all other hospitals.
“This possibly illegal, unethical patient care practice pads HCA’s pockets by costing taxpayers and consumers billions in reimbursement for unnecessary procedures and services, while also exposing patients to unnecessary risk,” the report says.
The report accuses HCA of Medicare fraud in the form of overpayments for services that are not needed. For example, in 2019, HCA hospitals in Florida may have received $100 million in Medicare overpayments for these admissions, the report says. And since 2008, that total may be over $1 billion in Florida, according to the report.
“With COVID, and health care budgets shrinking, we want to make sure that every dollar is accounted for and HCA has been making record profits while this is happening,” says Robert Gibson, Tampa region vice president for 1199 SEIU United Healthcare Workers. “Yet, our folks are underpaid and struggle to maintain their safety with proper PPE and things like that.”
HCA is the nation’s largest for-profit hospital chain. It operates nearly 50 hospitals in Florida. Representatives from regional and national offices did not respond to a request for comment.
SEIU members who work at some HCA hospitals in Florida have often complained about staffing and pay issues. Those complaints have also included a lack of proper protective equipment during the pandemic.
The company’s practice of overadmitting patients has left nurses and other health care workers overworked during the pandemic, Gibson says.
“Instead of taking care of three or four patients, they're taking care of 20,” Gibson says. “And that's not physically possible. You show up to work and you may find out that the person that you were working with now has COVID. So you're worrying about now do you have COVID? And then you also have to have an additional patient load. And this has become a chronic problem.”
Meanwhile, HCA pulled in $3.75 billion in profits in 2021, according to the report.
Overadmitting patients during a pandemic can create a shortage of beds for patients who need them, Gibson says.
It can also compound staffing shortages, he says.
“We constantly hear from our members about being short-staffed, having to constantly take call because there's not enough staff,” Gibson said. “Some of that money should be directed into making sure that there's enough staff on the ground, that patient care and staff are not compromised, as well as properly compensating those caregivers that have been here and are currently in the facilities.”
Decisions about whether a patient should be admitted to a hospital for a longer stay are typically based on a patient’s health. If a patient does not need to stay in a hospital, health advocates say, it’s better for them to be released on the same day.
SEIU is calling on regulatory agencies and Congress to look into HCA’s practice of overadmitting patients.
“We need to get to the bottom of these numbers,” Gibson says. “And secondly, HCA needs to do a better job of taking care of its employees through compensation through adequate staffing, and safety. HCA has the money to do it. They're just choosing not to.”
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