HMA blasts 60 Minutes report on excess ER admissions

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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.

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



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.