For months now, Franklin, Tenn.-based Community, which is the nation's second-largest for-profit hospital corporation, has been locked in an increasingly hostile takeover battle with its nationally ranked No. 3 rival and unwilling acquisition target, Dallas-based Tenet Healthcare Corp.
Tenet recently sued Community, alleging that Community misled investors about potential Medicare admissions liabilities. The suit said Community placed Medicare patients on "observation status" at rates significantly lower than the number-crunchers that Tenet had hired figure are warranted as compared with other hospitals. Tenet also said most hospitals use vendor-developed sets of evidence-based clinical criteria :to determine whether a patient qualifies for inpatient admission." In contrast, Community relies on its own, self-developed, paperback guidelines called the "Blue Book," a Tenet spokesman said.
To spice things up further, last Friday, Community publicly disclosed via an SEC filing that it had received a subpoena from the HHS inspector general's office. The subpoena "appears to concern emergency department processes and procedures, including our hospitals' use of the Pro-MED Clinical Systems, which is a third-party software system that assists with the management of patient care and provides operational support and data collection for emergency department management and has the ability to track discharge, transfer and admission recommendations of emergency department physicians," according to the filing.
Pro-MED was founded in 1991, Grossjung said in a telephone interview Tuesday. (No one from the company was available for comment on my earlier story.)
Initially, Pro-MED developed paper-based forms to help emergency-room physicians document patient encounters. It later switched to computerized records, Grossjung said.
"We've been doing business with Community since 1998," he said. His software is, obviously, in no way connected to the paper-based Blue Book. Of more importance, it doesn't rely on Blue Book criteria as a basis for any of Pro-MED's clinical decision-support functions, Grossjung said.
Regarding the inspector general's investigation of Community, "we have no reason to believe that we are involved at all," Grossjung said. "We have nothing to do or no role whatever in the reimbursement process. We produce a chart and they produce the claim. Whether they go to inpatient, that decision is solely the hospital's."