YOUR LABOR AND JUSTICE LEADERS KNOW THIS IS THE GOAL----IF THEY ARE SHOUTING FOR THE AFFORDABLE CARE ACT AND NOT EXPANDED AND IMPROVED MEDICARE FOR ALL----THEY ARE NOT WORKING FOR YOU AND ME!
Labor union leaders in Maryland are supporting Anthony Brown-----the one of three candidates that will continue this most global of corporate takeover of our public health system----the ACA. Only Cindy Walsh for Governor of Maryland shouts out for Expanded and Improved Medicare for All to keep our Federal program strong!
Labor Builds Support for Medicare for All
January 27, 2014 by Healthcare-NOW!
Filed under Single-Payer News
While Obamacare Enrollment Continues to Lag, Labor Builds Support for Expanded and Improved Medicare for All
By Pearl Korn for Huffington Post –
The 113th Congress will likely be remembered as the most unproductive in our history, and with an overall approval rating of 9 perent, it is safe to say that most Americans do not consider this bunch to be a noble group of public servants engaged in good works for the people of this country. It is rare that any member of Congress is honored on any level these days, but one truly worthy exception is Rep. John Conyers (D-MI), who early in December was honored with a breakfast celebration attended by some 40 union representatives at a restaurant on East 29th Street in New York City.
Those present included leaders from Actors Equity, The International Alliance of Theatrical Stage Employees (IATSE) and the New York City Central Labor Council (NYCCLC), whose President, Vincent Alvarez, declared his support for Mr. Conyers’ bill HR 676, The Expanded and Improved Medicare for All Act, and promised to deliver their 1.3 million members to back this cause. This is a very significant development, as the 300 unions under the umbrella of the NYCCLC are made up of truck drivers, teachers, nurses, operating engineers, construction workers, janitors, train operators, electricians, fire fighters, retail workers and many more hardworking Americans who, along with everyone else in our nation, would benefit greatly from this revolutionary healthcare plan. They are the face of American labor today, and Mr. Alvarez spoke of the need for labor and the general public to unite and work together for this imperative cause: providing affordable, quality healthcare to all Americans.
We might recall that it was labor that gave us the middle class during the post World War II years as they worked to indeed lift all boats in that time of unprecedented prosperity. Can they lead our nation once again in this time of unprecedented need? They have been taking quite a beating, and have been decimated in several states by the lackeys of the 1 percent. But their values are America’s values, and it is critical that they remain a vibrant force for change in this country.
Mr. Conyers was introduced by his longtime friend, TV talk show host Phil Donahue, and other speakers that morning included Robert Score, Recording-Corresponding Secretary of Local 1 of IATSE, and Stephen Shaff, speaking on behalf of Progressive Democrats of America. Mr. Conyers himself noted that it took him 15 years to move Congress to declare a national holiday for Dr. Martin Luther King, so he is prepared for a long haul to achieve Medicare For All. He has reintroduced HR 676 in every Congress since 2003, and has now garnered support from 54 other House members, along with an impressive 609 union organizations, including 146 Central Labor Councils/Area Federations and 44 State AFL/CIO’s. Obamacare’s failure to address the Taft Hartley Plans and the operating procedures under which they work could create even more union support for the Single Payer movement. The president must address this issue.
Meanwhile, support from the public also continues to build, as the warts on the ACA become more apparent and the questions about its viability grow louder on almost a daily basis. This will undoubtedly drag into the 2014 election and continue to send shock waves throughout the political world into the 2016 race for the White House, as the Conservatives will remain active in their attacks and continuing efforts to end Obamacare.
Following the breakfast, Mr. Conyers and his policy director Mike Darner met with 15 of his core Single Payer activist leaders from organizations like Physicians For A National Health Program and Healthcare-Now! — as well as some doctors — to discuss strategy and continue building the movement. This group is definitely in it for the long haul, too, as they have supported Mr. Conyers and his bill for years. This is a bill that would deliver all necessary health services at less than half the cost we pay now, eliminating co-pays, deductibles and co-insurance while providing long-term care — including all of those expensive dental specialties. The estimated savings would be in the range of $592 billion a year. Better healthcare at lower costs — what’s not to like? And if you like your doctor, you actually could keep him or her — did you hear that, Mr. President? You can also pick any doctor you like — no more provider networks. These healthcare professionals would be able to become doctors once again, instead of a “provider” or “vendor,” and we could become patients again, ending our dehumanizing role as a “consumer” or “customer.”
Of late, we have been reading about Medicare For All from such luminaries as Robert Reich, Ralph Nader and William Greider in The Nation, among others. Even Bill Clinton mentioned it during President Obama’s second campaign. If Hillary were to acknowledge that Medicare For All is the next logical step after Obamacare, she would gain tremendous support and a second opportunity to get the right healthcare plan in place for her presumed 2016 run for president. Unfortunately, Hillary has proven herself to be far from progressive on many issues in the past, so we will have to wait and hear from her what her healthcare plan actually is if she decides to run.
Meanwhile, in the past few weeks Vermont Senator Bernie Sanders and Rep. James McDermott (D-WA) — who is also a doctor — have both introduced Single Payer bills. Bernie’s bill is a Medicare-for-All proposal known as the American Health Security Act of 2013 (S.1782), which would be administered by the states and transferable between states. The McDermott bill also moves the initiative outside of D.C., leaving it up to the states to develop their own plans based on their diversity and individual needs. As Massachusetts was the template for the ACA, it makes sense to finally introduce Single Payer on a state-by-state level.
Vermont has approval in both of its houses for a Single Payer plan, but it needs a waiver from the ACA to implement it in 2017. Can’t the federal government speed up that process? There are also plans at the ready in New York and in Rep. McDermott’s home state of Washington. And what of California, which has come so close in the past? One state can lead the country toward this monumental goal, the way Massachusetts did with the ACA. We just need to find the will.
In the Greider article in this month’s The Nation, entitled “Reviving The Fight For Single Payer,” he raises the question many of us ask: Can Obamacare deliver what it promised? One of the major problems he notes is that “…the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies.” Rep. McDermott was interviewed for this article, and he pointed out another major flaw in the ACA: “In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system. We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.”
I have for years been shouting that the intent of the Affordable Care Act is simply the consolidation and deregulation of the health care industry just as Clinton did with the banking industry. So, the goal is to create global corporations of these health systems with little to no oversight and accountability just as with the banks. In order to maximize profits neo-liberals and neo-cons need to move all of public health into the private sector and that means ending the Federal programs Medicare and Medicaid. This has been a plan for republicans for decades and they are super-sized in glee with the Affordable Care Act. So, why do they pretend otherwise?
NO ONE HATES THE ELEMENTS OF THE AFFORDABLE CARE ACT THAN REPUBLICAN VOTERS.....THAT IS WHY NEO-LIBERALS ARE DOING IT AND WHY IT IS BEING DISGUISED AS 'HELPING THE POOR TO BE COVERED'.....which is a great big lie. I showed yesterday how Bill Gates and his new PHARMA connection is tied to the US Health and Human Services with Obama's new appointee..... and the connection to Medicare Advantage in privatizing Medicare. Let's take a look at why US PHARMA won big regardless of the 'fees' attached to drug manufacturing.
RAISE YOUR HAND IF YOU UNDERSTAND THAT TAX LOOPHOLES ALWAYS END ANY FEE OR TAX PLACED ON A CORPORATION! EVERYONE.
Below you see how the terms for Medicare are shifting----now the Federal Medicare program is called the original. Now, I wonder why neo-liberals would place a cap on costs for Medicare Advantage and not the 'original'? Seems more people are going to be forced to move to the private Advantage plan to cover costs. Parts A and B are the doctor visits and hospital care and as we know with our very private state health system in Maryland, the tiered insurance plans are keeping most people from access because of high co-pays and deductibles. Can you imagine that the average senior will jump to Advantage because of this 'cap' only on Advantage? Of course.....as with drug coverage and Medicare Part D....the only one anyone can afford will be the private plans.
“Original Medicare,” Parts A and B, does not cap out of pocket costs for beneficiaries.
Remember, the bonuses are paid if the expenditures from Medicare drop----it doesn't say how but it pays extra to stop re-admittance. Some of you may see where this leads already as it has been happening for the few years since this ACA was implemented.....if you have a chronic illness that brings you back to the hospital your doctor will get rid of you. Don't worry, these state health systems have some kind of plans for those chronic illnesses----it won't be the first or best choice----YOU BETCHA. Most doctors are now tied to the managed care system that is now incentivized to keep you out of the hospital if you are a repeat admittee---there goes choice. Hospitals are earning record profits from this exclusion.
So, for keeping you out of the hospital----Advantage will be able to recruit you year around----'original' Medicare only allows people the right to move annually. 'Original' is looking worse and worse ------kind of like defunded public education and transportation. They say it is better practices keeping you out of the hospital----OH REALLY? Staff shortages, quality of care falling, no oversight means no efficacy data....
NO-----you are simply being denied the ability to enter hospitals----that is what is keeping you out of hospitals.
.........authorized Medicare to pay bonuses to Medicare Advantage plans, beginning in 2012, if they receive four or five stars on Medicare’s new five-star quality rating system. And, plans that received a 5 star rating would be able to enroll customers year-round; not just during Medicare’s annual enrollment period (AEP). (Source)
Managed care was policy a few decades ago and failed because patients and doctors did not want it. It never proved to improve outcomes or lower costs. Fee for service has gotten a bad name because all oversight was dismantled from the Medicare and Medicaid Trusts and massive health industry fraud allowed doctors and health institutions to fleece the Trusts. So, the problem with Fee for Service was lack of oversight----not the policy. Allowing a doctor to follow their own course of treatment allows people to have individual care----A GOOD THING. IT ALLOWS HIPPOCRATIC OATH OF DOING NO HARM AS WELL. When doctor's are tied to doing what an insurance corporation or standardized treatment created by a small group of people-----they are no longer working under the Hippocratic Oath. They are most likely working under ----whatever is cheaper.
Posted on: Thursday, March 20, 2014
With Hippocratic Oath, doctors pledge allegiance to patients, not profits
By Philip Caper, M.D.
Bangor (Maine) Daily News, March 20, 2014
The Maine Medical Association recently updated a 2008 poll of their members that asked the question, “When considering the topic of health care reform, would you prefer to make improvements in the current public/private system (or) a single-payer system, such as a ‘Medicare-for-all’ approach?” In 2008, 52.3 percent favored the Medicare-for-all approach. In the updated poll, released last week, that number had risen to 64.3 percent.
It’s pretty unusual for two-thirds of a group of doctors to agree on something as controversial as a single-payer health care system. Until recently, doctors formed the core resistance to “government-run” health insurance in the U.S.
A number of factors account for this impressive change, but the huge administrative burden on practicing physicians created by our plethora of private insurance schemes is certainly near the top of the list.
The other day, I spoke with a Maine physician nearing retirement and looking forward to it. She was recently returning home after a long day in her practice, carrying her “homework,” a pile of administrative paperwork several inches high. Her husband asked her how she got so far behind in her paperwork. “I wasn’t behind at all,” she replied. She did this much paperwork, mostly insurance forms, at least twice a week.
American physicians spend at least three times as much time, money and effort on administrative work related to payment and insurance coverage as our Canadian brethren, with their single-payer system. Administrative hassle is a major factor driving more and more American doctors to sell our practices to large corporations that take care of the back-office work. The Affordable Care Act has only added to that burden. Sixty percent of doctors now work for corporations, and that number is growing.
Working for a corporate provider of health care services is a mixed bag. He who pays the piper calls the tune. As both for-profit and nonprofit health care corporations have become increasingly focused on the bottom line, doctors working for them have come under increasingly subtle and not-so-subtle pressures to generate revenue for their employers.
Some tests and procedures are more profitable than others. Increasingly, doctors’ “productivity” is measured by the amount of profitable revenue we produce rather than by the results we get for our patients. But in health care, profitability is a very unreliable measure of value because doctors’ fees and other health care prices are often set arbitrarily.
When we graduate from medical school, most of us take the Hippocratic Oath, swearing our primary allegiance to our patients. Young doctors tend to take their oath very seriously. Most doctors truly want to do what’s best for patients, not their insurance company or our employers’ bottom line.
But in today’s corporatized and increasingly monetized health care environment, the demands for generation of profit often directly conflict with our clinical judgment. The belief that doctors and other healers act as stewards for our patients’ welfare has long earned us a special place in society and the trust of our patients. That position and that trust, so critical to healing, is now threatened.
This conflict has made many doctors very angry. Practicing a profession that has traditionally been a calling has become a business. Doctors today are caught in a system corrupted by an excessive focus on money that is forcing us to behave in ways that conflict with our professional ethics. We are growing very tired of being told how to practice medicine by insurance company bureaucrats and corporate MBAs.
This is another major cause of the burnout experienced by increasing numbers of doctors. Many older doctors are now simply looking for a way out. Others are calling for systemwide reforms that will allow them to return to focusing on the welfare of their patients. Hence the results of the recent MMA poll.
In an excellent new book called “What Matters In Medicine,” longtime Maine family doctor David Loxterkamp points out that medical care, while often using scientific jargon, methods and tools, is at its core a profession about relationships, not profits. That’s something the bean-counters and policy wonks who have become increasingly influential in determining the nature of our corporatized health care system seem unable to understand.
It’s time to remove corporate profit from the financing of health care, and perverse financial incentives from the direct provision of services. It’s time for improved Medicare-for-all.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at firstname.lastname@example.org.
- Payments to Medicare Advantage plans were restructured so more is paid for managed care and less is paid for fee-for-service (FFS).
Raise your hands if you see the problem with hospital systems giving bonuses for completing care for a bundled fee that Medicare has greatly reduced because of an almost trillion dollars in cuts to Medicare? I listened to doctors discuss the merits of taking an X-ray of a broken bone because to not do so would save money on this bundled Medicare payment. We are seeing hospitals earning big profits on both Medicare and Medicaid from these bonuses for coming under an already too low Medicare remittance.
If the doctors come in over the amount Medicare pays in bundled fees----the doctors give back the money. What do you think these newly corporatized doctors will do? Come in under any way possible. See where Hippocratic Oath flies out the door and any doctor who has ethics hates this? We will end up with the same kind of people as doctors as we have in the banking industry-----
LIE/CHEAT/STEAL YOUR WAY TO WEALTH THROUGH CORRUPT HEALTH CARE PRACTICES.
By Coming Under Target Cost, Providers Can Share in Savings
Similar to a car, the bundled payment initiative comes in different models, each with its own element of risk and reward.
Model 1 focuses solely on inpatient care. Medicare will pay a hospital a discounted amount — which serves as a target to beat — for any kind of episode of care, based on the rates set under the Inpatient Prospective Payment System. Physicians involved in patient care will receive their regular Medicare fee-for-service (FFS) rates. If the hospital can come under the target amount through more expedited, higher-quality care, it can reap the savings and share them with partnering physicians.
On January 31, CMS released a list of 32 hospitals that will implement model 1 as early as April. Twenty-nine are in New Jersey, 2 in California, and 1 in New York.
In model 2, the bundled payment covers a hospital stay and follow-up care, including physician services and hospital readmissions, for up to 90 days after discharge. Participants can select up to 48 clinical condition episodes for bundled payments. They include:
- major joint replacement of the lower extremities,
- chronic obstructive pulmonary disease with major complication or comorbidity,
- permanent cardiac pacemaker implant with complication or comorbidity,
- renal failure with major complication or comorbidity, and
- syncope and collapse.
Model 3 operates in the same way as model 2, except that it involves only services in an SNF, inpatient rehabilitation facility, long-term care hospital, or home health agency. There is no inpatient component. The episode of care is triggered by a prior hospital stay for any 1 of the 48 conditions. The IBJI in Chicago applied to participate in this model.
Reduce Payments for Insufficient Care – The ACA reduces Medicare payments to hospitals by specified percentages when patients are excessively readmitted for things that could or should have been prevented.
Changes to Medicare Upheld by the Supreme Court Ruling on the Affordable Care Act
By Ross Blair on July 11th, 2012
The Affordable Care Act (ACA) made a number of changes to the Medicare program that were upheld by the Supreme Court ruling on the constitutionality of the law. Major consumer-focused provisions of the law are summarized below.
Provisions of the ACA Currently in Effect for Medicare:
Annual Out-of-Pocket Limits on Medicare Advantage plans – The ACA placed a maximum out-of-pocket limit on Medicare Advantage plans of $6,700. “Original Medicare,” Parts A and B, does not cap out of pocket costs for beneficiaries. But, the ACA placed a mandatory maximum limit of $6,700 on all out of pocket medical costs for Medicare Part C (Medicare Advantage) plans. This limit is referred to as the “Maximum Out of Pocket” or MOOP. (Source)
New dates for Medicare’s Annual Enrollment Period (AEP) –
During AEP, Medicare beneficiaries have the option to review and change their Medicare Part D and/or Medicare Advantage health coverage prior to the coming plan year when new plan benefits go into effect. Prior to the passage of the ACA, Medicare’s AEP began on November 15 and ended on December 31. But, the ACA changed those dates for the 2012 plan year. The 2012 AEP began on October 15 and ended on December 7, 2011. These dates are currently in place for all AEP’s going forward.
Five Star Ratings on Medicare Advantage Plans –
To encourage Medicare Advantage plans to provide quality care, the ACA authorized Medicare to pay bonuses to Medicare Advantage plans, beginning in 2012, if they receive four or five stars on Medicare’s new five-star quality rating system. And, plans that received a 5 star rating would be able to enroll customers year-round; not just during Medicare’s annual enrollment period (AEP). (Source)
The rating system measures how well plans: help customers stay healthy; perform on numerous customer satisfaction measures; price and safely administer drugs; and provide Medicare.gov updated plan information.
Increased Part B and Part D Premiums for Wealthy –
People with incomes above $85,000/individual and $170,000/couple pay more for Medicare Part B and Part D services (https://questions.medicare.gov/app/answers/detail/a_id/2306).
Provisions of the ACA Not Yet in Effect for Medicare (http://www.kff.org/healthreform/upload/8061.pdf):
Changes in Plan Payments - Payments to Medicare Advantage plans were restructured so more is paid for managed care and less is paid for fee-for-service (FFS). New payment structures are phased-in over a 3 to 6 year period, depending on the region. Bonuses are given to plans that receive higher quality scores. And, Medicare Advantage plans must send rebates to the government if they have a medical loss ratio of less than 85%, beginning in 2014.
Creation of An Independent Payment Advisory Board (IPAB) –
This 15-member group must make recommendations on how to reduce per capita rate of growth in Medicare spending, if spending exceeds a target growth rate. This begins April 2013 when Medicare’s Chief Actuary must forecast whether or not Medicare spending will exceed target rates. If reductions are necessary, the Board will submit recommendations on how to reduce Medicare spending by January 15, 2014.
Accountable Care Organizations –This provision allows providers to organize into Accountable Care Organizations (ACOs), which must agree to be accountable for the overall care of their Medicare beneficiaries and have adequate participation of primary care physicians, define processes to promote evidence-based medicine, report on quality and costs, and coordinate care. Those that form ACOs and voluntarily meet quality thresholds will share in the cost savings they achieve for the Medicare program. (Effective in 2013)
Reduce Payments for Insufficient Care – The ACA reduces Medicare payments to hospitals by specified percentages when patients are excessively readmitted for things that could or should have been prevented. (Effective October 1, 2012). Medicare payments are also reduced to hospitals when a patient acquires a condition while in the hospital. Fees are reduced by 1%. (Effective fiscal year 2015)
- See more at: http://blog.ehealthinsurance.com/2012/07/changes-to-medicare-upheld-by-the-supreme-court-ruling-on-the-affordable-care-act/#sthash.yiS66EaK.dpuf
Sunday, June 30, 2013 - Page updated at 07:30 p.m.
Hospitals reward CEOs for profit over quality care
Editor’s note: Kaiser Health News, an editorially independent news service, is a program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. KHN stories appear in media outlets nationwide and on its website at www.kaiserhealthnews.org.
By Jay Hancock
Kaiser Health News Like hospital leaders everywhere, the people running Valley Medical Center in Renton talk frequently about the need to control soaring medical costs.
“We are working to reduce the overall cost of health care and to transform health-care delivery,” Lisa Jensen, chairwoman of the hospital’s board of trustees, said last year.
Experts believe that’s a good prescription for the entire U.S. health industry, which costs the economy far more than systems in other developed countries, delivers mediocre results and is widely seen as unsustainable at its current growth rate.
But even as Valley officials talk about change, they’re paying hospital CEO Richard Roodman tens of thousands of dollars in bonuses for driving the kind of profits and expansion many say are no longer affordable for patients, employers and taxpayers.
We all know what will happen as health care institutions consolidate and grow to global corporations that create monopolies-----they will act just like Wall Street banks. Forget the idea that they are working to create some efficient system----they just want to be able to track how best to bring the money in.
Remember, health industry fraud and profiteering is the problem with cost and the ACA simply sets the health system up to super-size this! Efficiency in bundled payment?
WATCH OUT GRANDMA!!!!!!
Medicare fraud and for-profit hospitals ... a story that never ends
By Maggie Mahar
June 13, 2013
- Sixty Minutes report focused on a hospital chain that ‘relentlessly pressured’ doctors to ‘put heads on beds.’
- FBI affidavit: ‘rainmaker’ heart surgeons sliced open patients who ‘should never have been on an operating table.’
Follow us for more.
Sunday, CBS’ Sixty Minutes took a close look at Health Management Associates (HMA), a for-profit hospital chain that, according to its employees, has “relentlessly pressured its doctors to admit more and more patients – regardless of medical need-in order to raise revenues.”
“We talked to more than 100 current and former employees and we heard a similar story over and over,” CBS correspondent Steve Kroft reported. Emergency room physicians were told “that if they didn’t start admitting more patients to the hospital, they would lose their jobs.” The orders came from the top:
With 71 hospitals in 15 states, HMA is the fourth-largest for-profit chain in the country. Last year, it raked in revenues of nearly $5.8 billion; half of that came from Medicare and Medicaid. In other words, taxpayers were footing the bill for a large share of those unnecessary hospitalizations.
Patients also paid. As one doctor observed: “If you are put into the hospital for reasons other than a good, justifiable medical reason, it puts you at significant risk for hospital-acquired infections and what we would refer to as ‘medical misadventure’” (i.e. preventable medical errors).
“Putting heads on beds” – an old story The piece was shocking. But it is not a new story. It is an old story. To be more precise, it is a never-ending story. In Money-Driven Medicine: The Real Reason HealthCare Costs So Much, I profiled several for-profit hospital companies that did just what Health Management Associates has done: “put heads on beds” even though the patient didn’t need to be hospitalized.
At Tenet, in Redding, California, patients weren’t just hospitalized, they underwent heart surgery. An investigation would reveal that in many cases, they “had no serious cardiac problems whatsoever.”
An FBI affidavit estimated that in one-quarter of all cases, Tenet’s two “rainmaker” heart surgeons were slicing open patients who should never have been on an operating table. Other doctors tried to alert the hospital’s administration. They were ignored.
Some of those patients did not survive. Others were crippled. All suffered psychological trauma.
HCA: Florida Governor Rick Scott’s back story In 1997, Health Corporation of America (HCA) made headlines when FBI agents swarmed HCA offices in five states, and found evidence that at HCA, executive salaries hinged on meeting financial targets such as “growth in admissions and surgery cases.”
The FBI also discovered that HCA had been keeping two sets of books – one to show to Medicare, a second that contained the real numbers. Ultimately, the investigation would reveal that the hospital chain had been bilking Medicare while simultaneously paying kickbacks to physicians who steered patients to its hospitals.
Just as at HMA, whistleblowers said that the directives came from the top. Rick Scott, who would later become governor of Florida, was the CEO of HCA.
In 2000, HCA finally settled with the government, pleading guilty to no fewer than 14 felonies – the biggest case of Medicare fraud ever. The company paid $1.7 billion in fines.
No one went to jail – probably because the Frist family (as in Senate Majority Leader Bill Frist) had founded the hospital and hired Scott to run it. (Some would say he was hired to do their dirty work.)
HCA settled with the government shortly before the Senator’s brother, Dr. Tommy Frist, (who served as HCA’s chairman) was scheduled to be deposed by the government’s attorneys.
Rick Scott was never indicted, and waltzed away with $10 million in severance. In 2009, when he led a committee to kill health reform, I told his story on HealthBeat, and wrote about him again when he became Florida’s governor.
For-profit hospital chains: the pattern Tenet, HCA and HMA are just three examples of corrupt for-profit hospitals. After defrauding Medicare and hurting patients for years, these chains are caught, and pay a huge fine. No one goes to prison. Frequently they change the name of the chain, paint the front door, hire executives who are cronies of the former management team, and start all over again.
Update: Sure enough, HMA CEO Gary Newsome has announced that he will be retiring July 1. Newsome, 55, said in a news release that he is stepping down after being “called by the First Presidency of the Church of Jesus Christ of Latter-day Saints to serve as the president of its Uruguay-Montevideo mission.” (It appears that he’s getting out of Dodge.)
Newsome, who has been at the helm of the company since September 2008, took home $8.3 million in total compensation last year.
Meanwhile, the word on Wall Street is that HMA is now a takeover target. Bloomberg reports that, according to financial analysts, Community Health Systems (CHS), a sister for profit hospital chain is the most likely suitor.
HMA and CHS have quite a lot in common: CHS has disclosed that it, too, has received requests for information from numerous law-enforcement agencies regarding its admissions policies, some of which are based at least in part on whistle-blower allegations. Unfazed by charges of wrong-doing, shareholders have sent HMA’s share price soaring, up 25% in a week. ( Typically, takeover rumors spur buying.)
Why do they do it? The hospital industry is a tough business, and it’s not easy to make the fat profits Wall Street expects. This is why the whole idea of trying to make hospitals “for-profit” is a truly terrible idea. Too often, shareholders’ interests trump patients’ interests.
More importantly, the hospital business is a labor-intensive, capital-intensive business. It just about impossible to reap the returns investors demand – unless you become creative.
Non-profits follow the for-profits
This is not to say that for-profits have a monopoly on fraud. A few years ago, a whistle-blowing doctor at a non-profit Catholic hospital contacted me. The administration at his hospital was pressuring doctors to admit ER patients. The hospital ultimately closed down his practice, transferring his patients to other doctors at the hospital. But he didn’t back down.
Unfortunately, no one at the hospital would talk to me. And none of the doctors’ colleagues would talk on the record – though they had all heard the CEO tell staff they were going to have to hike admissions from the ER.
His partner did talk to me and corroborated the story, but wouldn’t talk on the record. It is so sad; people are so afraid.
I was seriously disappointed. This had all the elements of a great story: The Catholic Church! Nuns! Blood! Money! A guy who is willing to stand up!
I will always remember this physician. He was in his early 60s, and devastated when they closed his practice and he lost so many long-time, patients. Many of them were older, and he told me he kept a notepad by his bed, in case, during the night, he thought of something that he should check on regarding one of his patients.
After he lost his practice, his girlfriend left him.