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Does HCA Follow Best Practices?

Karen Minich-Pourshadi, for HealthLeaders Media, September 10, 2012

I don't wish to belittle these incidents, or how painful and severe bed sores are to patients, only to make the point that their occurrence may not be solely attributable to HCA's profit motive—rather, they may also be a reflection of some of healthcare's larger woes.

But HCA's practices over the years haven't been beyond reproach, and in fact HCA is in hot water again with the Justice Department, which recently launched a review of cardiac businesses at 10 HCA hospitals. The investigation is intended to discern if some HCA hospitals conducted unnecessary procedures and therefore resulted in unjustified reimbursement from Medicare and other insurers.

Though only 10 hospitals are under review, ultimately the Justice Department has another 153 hospitals to choose from and hundreds of thousands of employees with the potential to complain of HCA practices.

Though folks may have chided HCA for its aggressive billing tactics, much of what the organization does has also been modified and imitated by other healthcare providers. HCA managed to garner more revenue from private insurance companies and Medicare by aggressive billing practices. They worked the coding system to their advantage (note that HCA was never formally charged with up-coding).

By way of explanation at the time, HCA said the change in coding practices better reflected the services provided. Partly as a result, its earnings increased $100 million in the first quarter. That's a profit to be proud of, unless the government rules otherwise.

Some people also take umbrage with HCA emergency room triage tactics, which are designed to discourage non-urgent care patients from using the ED for care. Patients are assessed by caregivers and then non-urgent patients are discouraged from staying (though physicians can override the system to treat a patient as necessary).

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