HMA blasts 60 Minutes report on excess ER admissions

Despite two federal subpoenas into its emergency room and admissions practices, Health Management Associates (HMA) maintains it does not overly admit patients from the emergency department to gain Medicare reimbursements, as recent allegations have accused the Florida-based health system of.

Getting ahead of a forthcoming exposé from 60 Minutes, set to air Dec. 2, HMA this morning released its admissions data to the media. HMA called the 60 Minutes piece a wrongful portrayal, the News-Press reported.

"Our data reflect no significant changes and is in line with industry norms," Alan Levine, HMA senior vice president, said on a conference call.


"Our data reflect no significant changes and is in line with industry norms."

Although the 60 Minutes piece has yet to air, HMA responded to what it anticipates will be accusations based on the questions the news outlet asked Levine during interviews.  

HMA said there's "no validity" to assertions that it excessively admits patients from the emergency department, pointing out that administrators have no role in whether a patient who comes through the ER doors is admitted as an inpatient--a decision made from the primary care physician or specialist, with consultation from the ER doctor.

Admission rates at HMA
Eric Waller, chief marketing officer, said "there's no significant difference between national averages and us," discussing the data during the years in question of 2008 and 2011.

For example, Carlisle Regional Medical Center, one of its hospitals in Pennsylvania, admitted an average of 34.4 percent of inpatients from the ED, while the national average was 42.2 percent in 2008. In 2011, Carlisle admitted 40.7 percent, slightly more than the national average of 40.1 percent.

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Hospitals stuck between a rock and a hard place
HMA's response to the excess admissions accusations highlights hospitals' continuing push-and-pull of admission versus observation status--the subject of the American Hospital Association's lawsuit against the Centers for Medicare & Medicaid Services.

"All hospitals are facing the same challenge," Levine explained." When we put a patient on observation, we hear about it from the patient," he said about Medicare's policy to not reimburse for post-acute care after hospital observation status, leaving patients with large copays. "If we admit, then we're accused of inappropriate admissions."         

Medicare initially intended observation status for patients who stay at the hospital for less than 24 hours. However, with increased focus from RAC auditors on admission rates, hospitals may feel pressured to keep patients on observation status for longer to evade audits--a trend that Levine said has a "disgraceful impact," particularly on senior patients.

Observation stays at hospitals have jumped 25 percent from 2007 to 2009, according to Brown University researchers in a Health Affairs study in June.

"We tell our physicians, 'Do what is best for your patients,'" Levine said about administrators' advice to physicians, encouraging them to place patient care ahead of administrative and business motivations.

Emergency department practices
The two subpoenas came to light in August 2011 when HMA disclosed the federal actions in SEC filings, the Naples Daily News and the Associated Press previously reported. Federal investigations requested information on the company's physician referrals and physician joint ventures, as well as emergency room management, specifically on the use of Pro-Med software--a program that HMA no longer uses, according to officials.

The healthcare operating giant, with 70 hospitals and 10,500 beds, said its emergency department physicians are not employed and the system has no say in the hiring or firing of those ED doctors (which are decisions left up to the practice group or individual hospitals' medical staff processes). Levine, however, pointed out the contracted physicians are still subject to compliance rules.

He also said Pro-Med, the emergency software to order tests, is compliant and similar to other industry software with its evidence-based order sets.

"Pro-Med is nothing more than a checklist to make sure patients don't get exposed to unnecessary (tests)," Levine said.

HMA said the decision to switch from Pro-Med did not have to do with any problems with the program.

Patient safety and staffing at Carlisle
HMA has been under the public microscope not only for admissions from the ED but for recent state patient safety citations at Carlisle. Last year, the health department found that two patient deaths at Carlisle Regional Medical Center were associated with low nurse staffing levels. Although the hospital insisted the quality of care is excellent, the Pennsylvania Department of Health found having too few nurses in the hospital did, in fact, play a part in one patient waiting for a hospital transfer and another patient waiting to undergo a scan.

HMA said it addressed the staffing shortage with aggressive recruitment. HMA also said it carefully monitors admissions data every day primarily to ensure proper staffing ratios to accommodate for patient volume. At the same time Carlise was cited, The Joint Commission called it one to the top-performing hospitals that year.

For more information:
- see the webcast slides (registration required)
- see the News Press article
- read the Naples Daily News and the Associated Press report

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