ViVE 2023: For-profit, large-scale healthcare does not mean poor quality, HCA Healthcare CEO says

NASHVILLE, Tennessee—HCA Healthcare CEO Sam Hazen took time during his keynote address at ViVE 2023 to discuss how his health system’s profit-fueled growth over the past decade is a boon for patient care—a contrast to the scrutiny his organization has received from employees, labor groups and lawmakers as of late.

“There’s a little bit of a notion that for-profit healthcare and high-quality care are incompatible. We see it just the opposite,” Hazen said to the conference attendees gathered in HCA Healthcare’s hometown. “We see significant opportunities for us to leverage that status to benefit our patients. And our whole agenda, from our technology agenda to our workforce development agenda to our care transformation agenda, is geared toward improving patient care.”

HCA Healthcare has nearly doubled its annual total assets over the past decade, growing to a collection of 180 hospitals, about 2,500 outpatient facilities, 285,000 employees and 50,000 affiliated physicians. The half-century-old system cares for about 38 million patients across its 40 U.S. communities and central London presence, the executive said, and closed 2022 with $60.2 billion in total revenue and over $5.6 billion in net income attributable to the company.

But the large for-profit has come under fire as of late for operating decisions in some hospitals that impacted patient care.

A February report from NBC News, for instance, detailed a Florida HCA hospital’s hygiene issues, heavy clinician turnover and a rise of patient safety events that has since triggered an inquiry from Republican lawmakers Sen. Marco Rubio and Rep. Gus Bilirakis.

The union SEIU has also aired a litany of grievances against the for-profit hospital operator lately, which range from short staffing-induced “patient care failures” to alleged company policies that drive unnecessary care for increased reimbursement.

Hazen was of a different mindset. He told the audience that HCA’s recent growth has facilitated “more convenient” health services for patients and “a better environment” for its physicians.

“And that’s allowed us to improve our quality,” he said. “We have metrics to support that, we have growth to support that, we have new offerings to support that. We would not be successful if we were not centered on that.”

The company will continue to use its scale to both streamline operations and improve patient care, Hazen continued. HCA’s work to consolidate administrative functions across the organization’s geographies has helped reduce expenses to the point where “our cost per patient in that category is probably 50% of the industry average,” Hazen said.

Ongoing work to overhaul and standardize HCA’s data systems also presents an opportunity to draw insights from the organization’s millions of annual patients and feed them back to clinicians and managers, a “generational” shift in thinking that is being embraced by the industry’s up-and-coming physician workforce, Hazen said.

“HCA Healthcare is an incredible ‘human-learning’ organization,” he said. “If we can put the machine underneath the power of our clinicians and our people, then I think we can start taking those patterns and bringing them back into the care process and really advance the outcomes for our patients, get more efficient in the process. So that’s where we’re headed.”

The executive said HCA has several partnerships with tech companies such as Google and Meditech that will help the hospital operator “learn how to manage data more effectively in the cloud and turn it into really leverageable assets from the scale.” But the company is still on the lookout for “smaller” tech partners interested in developing and implementing point solutions—so long as they’re able to work at HCA’s scale.

“We’re big in the healthcare industry, and the bigness sometimes, and the diversification from Miami to Anchorage, Alaska, can yield differences that aren’t understood and slow down the adoption in a way that is not as productive,” he said. “So our partnerships are geared toward ‘OK, if it’s a point solution, how do we make sure it can scale? How do we make sure it really solves the problem?’ And we’ve had success with that in some cases; in other cases, we haven’t.”