VHA, an Irving, Texas-based hospital alliance, is reviewing preliminary data in a study it is conducting that indicates "cream-skimming" of profitable patients by physicians who own stock in Columbia/HCA Healthcare Corp. hospitals in Florida, MODERN HEALTHCARE*has learned.
The study is the latest salvo in the public relations battle between the not-for-profit and for-profit sectors of the hospital industry. VHA and other alliances have sparred with Columbia during the past year over who better serves the public interest.
Meanwhile, state officials in Florida, who are conducting their own study of physician referrals, said they will delay release of their report until they have looked at VHA's study.
Columbia has offered equity ownership to physicians at more than 40 of the 60 hospitals it owns in Florida. Under Columbia's physician investment program, individual doctors can own up to $150,000 in stock in a Columbia regional group for a combined maximum of 20% of the assets of the group.
Physician investment is a key strategy for Columbia, which owns 341 U.S. hospitals. In previous interviews, Columbia officials have said physician ownership encourages doctors to practice efficient and high-quality medicine by aligning incentives.
Columbia officials were unavailable for comment at press time.
But critics contend that Columbia's investment program encourages physician owners to send profitable patients to Columbia's hospitals and unprofitable or uninsured patients to other hospitals.
Last March, a physician in Corpus Christi, Texas, filed a whistleblower lawsuit against Columbia for its physician investment strategy (Sept. 4, 1995, p. 16). In his suit filed in U.S. District Court in Corpus Christi, James Thompson, M.D., charged that Columbia induces physicians to refer patients to its hospitals by offering investment opportunities and consultation fees. Columbia officials denied the charge and said they would fight it.
A spokesman for Rep. Fortney "Pete" Stark (D-Calif.) said the congressman is aware of VHA's preliminary findings. If the findings hold up in the final report, Stark may hold hearings on Columbia's physician investment strategy and the overall effect of hospital ownership of non-acute-care services on small medical businesses that compete with Columbia and other large integrated delivery networks, the spokesman said.
Stark also has requested a copy of the final VHA study and of a similar report conducted by the state of Florida in 1993.
Although that report was never released, the Florida Agency for Health Care Administration said in a draft there was evidence of "the possibility of cream-skimming" by physician investors at a now closed Columbia-owned hospital in South Florida.
While details of the VHA study were not available, several sources who have been briefed on preliminary findings told MODERN HEALTHCARE*the findings show major differences between not-for-profit hospitals and investor-owned hospitals.
Other preliminary findings showed that for-profit hospitals were 4% more profitable, on average, than not-for-profit hospitals and that they cared for fewer sick patients.
Mack Haning, a VHA spokesman, confirmed the report will include the examination of physician referrals. He characterized the report as "preliminary work" and would not comment further.