“60 Minutes” recently reported that Health Management Associates (HMA) demands a 20 percent rate of admissions from some of the emergency departments in the 70-hospital system.
The clear implication was that doctors were under pressure to admit patients who did not require a hospital stay. Doctors interviewed for the piece said they were threatened with dismissal if they fell short of the quota.
But the CBS news magazine show left out the fact that, nationwide, admission rates from EDs are well above 20 percent. In fact, the ED is becoming the main portal for admissions. The New England Journal of Medicine reported earlier this year that from 1993 to 2006, admissions from EDs increased from 33.5 percent to 43.8 percent and that “since 1993, EDs have played an increasing role in admissions for almost all conditions.”
So the question is, why would HMA have to set a quota for ED admissions when the national rate far exceeds the standard they’re alleged to have set.
Did the show’s producers approach the story with a skewed point of view? It’s not surprising that hospital fraud would be the centerpiece of a “60 Minutes” investigation. It’s a lot more sexy than hospital inefficiency. In fact, fraud is the kind of subject that has kept the show running for decades. And they are very good at exposing it.
What we find ironic is that “60 Minutes” chose fraud as an example of waste in the U.S. healthcare system, when the Institute of Medicine showed recently that more of the $765 billion wasted in healthcare every year can be attributed to plain old inefficiency ($300 billion) than unnecessary treatment and testing ($200 billion). (See Eliminate Waste From Healthcare: TeleTracking Vision for Future.)
Reporter Steve Kroft began the “60 Minutes” piece by saying that an estimated “$210 billion a year goes toward unnecessary tests and treatments,” much of it coming “right out of the pockets of American taxpayers.”
“We heard a similar story over and over,” Kroft intoned. “HMA relentlessly pressured its doctors to admit more and more patients – regardless of medical need – in order to increase revenues.”
Yet, as HMA noted in a public statement, “60 Minutes” failed to identify a single patient who had been inappropriately admitted, including by the physicians interviewed. And there was no example where a physician’s medical judgment was overridden by an HMA executive, much less to defraud Medicare.
There undoubtedly will be more to come. The Department of Justice is now investigating the issue of coerced fraud. HMA executives blame the allegations on disgruntled physicians involved in lawsuits against them.
Whether the allegations appliy to HMA is not the point here. Our point is that if 60 minutes wanted to fix the waste problem, they should know that it’s a lot easier to fix hospital inefficiency than to stop fraud.
EDs in America and around the world have been dealing with an overcrowding crunch for several decades. We know because part of our business is to ease that pressure by improving patient flow throughout the hospital. And we also know that a large part of the overcrowding problem is due to plain old inefficiency. We’ve been proving for years that workflow automation can deliver big savings and better bottom lines to hospitals all across America.
Perhaps “60 Minutes” should look into why inefficiencies exist in healthcare to the degree they do.
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