HCA defends against ER, billing allegations

In the wake of allegations that HCA aggressively performed cardiac services for higher reimbursements, the New York Times is questioning its emergency department and billing practices.

The Times alleges that the 163-hospital system, based in Nashville, Tenn., changed its billing codes so that emergency patients would appear sicker than they actually were.

In 2006, HCA had slightly more than a quarter of Medicare payments classified in the two highest-paying categories, far behind the 58 percent reported at other hospitals, according to the newspaper's analysis of American Hospital Directory data.

But, in 2008, HCA changed billing codes, based on guidelines from the American College of Emergency Physicians, resulting in 76 percent of its payments coming from the two most expensive categories, compared to 74 percent at other hospitals. Operating earnings soared by about $100 million in 2009's first quarter, the Times noted.

"Nearly overnight, HCA's patients appeared to be much, much sicker," according to the Times.

An HCA statement reiterated that the model is based on the ACEP's method and "is used by many hospitals because it provides for greater consistency and simplicity."

The newspaper also alleged HCA attracted emergency patients to acquire admissions, yet encouraged physicians to divert emergency patients who didn't qualify as a real emergency or couldn't pay.

With billboard campaigns, advertising HCA's ED services, annual emergency visits climbed 20 percent from 2007 to 2011, Times reported.

HCA, however, said it does not have quotas and added that only one in every 100 patients were deemed non-emergent in 2011.

For more information:
- read the Times article
- see the HCA statement (.pdf)

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