HMA execs defend ER admissions rates

Health Management Associates executives defended admissions from the company's emergency rooms as comparable with national averages and local competitors ahead of an expected “60 Minutes” story.

Alan Levine, HMA's senior vice president and president of the company's Florida group, who was interviewed in October by “60 Minutes,” said on a call with investors that the company does not know the specific content of the television news program. Levine said he would address potential subjects of the story based on questions during his October interview.

An analysis by an outside company found no spike in admissions from emergency rooms, Levine said. HMA contracted with Opera Solutions, a data analytics company, which looked at emergency room admissions between January 2008 and July 2011. The data were provided to CBS, he said.

Emergency room physicians under contract with HMA consult with patients' physicians, who decide whether to admit patients, he said. “Simply put, administrators cannot and do not admit patients,” Levine said.

The company and industry face significant challenges related to regulation of hospital admissions and oversight of patients who remain at the hospital for observation, Levine said.

Kevin Tedesco, a spokesman for CBS, said in response to the investor call: “What we have to report will be in our story Sunday.” He declined to comment further.

Sunday's broadcast includes an investigation of “allegations from doctors that the hospital chain they worked for pressured them to admit patients regardless of their medical needs,” according to the “60 Minutes” website. The listing does not identify the hospital chain.

Both HMA and its for-profit peer Community Health Systems of Franklin, Tenn., have disclosed in filings with the U.S. Securities and Exchange Commission that they have received requests for information from numerous law-enforcement agencies regarding their admissions policies, some of which are based at least in part on whistle-blower allegations.

On Nov. 2, HMA disclosed that it believed authorities were investigating whether outside vendor software had caused the system to make medically unnecessary inpatients admissions from its hospital emergency departments, among other things. HMA was served with subpoenas from HHS' office of inspector general in May 2011 and July 2011. The civil divisions of U.S. attorneys' offices in several states are also investigating, according to the SEC filings.

CHS, meanwhile, received office of the inspector general subpoenas in April 2011 related to an investigation of admissions practices at all of CHS hospitals using the same software cited in the HMA filing.

CHS was publicly accused in a lawsuit by its industry competitor Tenet Healthcare of using the software, made by ProMed Clinical Systems, to find ways to increase expensive inpatient admissions rather than send patients into less-expensive treatment options. CHS publicly rebutted those allegations, saying its hospitals followed industry patterns of use when it came to admissions. The Tenet lawsuit was dismissed with prejudice by a judge.

CHS also disclosed in SEC filings that an existing False Claims Act complaint against CHS includes allegations that are related to the allegations in the Tenet case, and that its investigation was ongoing.

In a Nov. 8 interview, Tom Grossjung, the owner of ProMed Clinical Systems, denied any allegation that the company's software would be used to override physician judgment in admissions decisions.

“That's absolutely not true,” Grossjung said of the allegations. “The software itself is simply a tool to help them manage their patients through the emergency department. It basically provides them the means by which they can document an encounter appropriately.”

Grossjung said that the system gives doctors the ability to “to assimilate the data in real time and evaluate what is proper,” but that the software does not override physician judgment on who should be admitted. “The disposition is from the doctor. It is their call 100% of the time,” he said.

In May, "60 Minutes" contacted the American Academy of Emergency Medicine to identify HMA physicians; the news organization in its message cited the government inquiries into emergency-room admissions and HMA's use of ProMed, according to the AAEM website.

An earlier version of this story gave an incorrect full name for ProMed Clinical Systems.



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