HMA Exec Says Physicians ‘Grossly Mischaracterized’ Admissions Management

Written by on December 31, 2012 in Law & Finance - No comments

Physicians interviewed for a “60 Minutes” investigation into Health Management Associates’ admissions practices “grossly mischaracterized” what goes on at the for-profit hospital chain’s facilities, a top executive for the company said after the segment aired Sunday, December 2.

Alan Levine, senior vice president at HMA and president of its Florida group, said some of the doctors who spoke to reporter Steve Kroft had reasons for doing so, including ongoing litigation with the company. Levine said HMA provided an incredible amount of information to “60 Minutes” suggesting the core issue is not about inpatient admission goals or quotas, but rather about the challenge hospitals face in managing patients between observation stays and inpatient admissions. The CBS program did not explore that topic.

The “60 Minutes” investigation of HMA found the nation’s fourth-largest for-profit hospital chain pressured physicians to admit patients to its hospitals by setting admission quotas.

“Hospitals throughout the United States are struggling with how to manage the issues specifically related to RAC (recovery audit contractor) audits with how to manage these patients between observation and inpatient admission,” Levine said. “Because we are heavily engaged in this, it’s easy for people to mischaracterize admission rates.”

Levine also emphasized that a company called Opera Solutions conducted an independent analysis of HMA’s admission percentages and found no difference from the rest of the industry.

A significant part of the program focused on allegations from the company’s former compliance director, Paul Meyer, who said HMA’s admission practices were profit-driven and represented Medicare fraud. Meyer, a former employee with the FBI, brought his concerns to top management. Levine said Gary Newsome, HMA’s president and CEO, took Meyer’s concerns very seriously and hired an outside law firm to investigation. The firm’s months-long probe found no evidence of wrongdoing, according to Levine, who served as the secretary of health and hospitals for Louisiana from January 2008 until August 2010 and as Florida’s secretary of healthcare administration from 2004 to 2006.

“I’ve been in these trenches,” Levine told Modern Healthcare. “I know the difference between fraud and people trying to act appropriately in an impossible maze of rules—which is what hospitals are dealing with now.”

Reporter Kroft noted that “60 Minutes” interviewed 100 current and past employees at the company and reviewed documents, including company e-mails. The segment also included a clip of a deposition last summer by former HMA Executive Vice President Jon Vollmer, who said the push to boost admissions came from straight from the top—specifically from Newsome.

Mr. Newsome’s thought was that an average of 16% was accomplishable at all hospitals or more and we should seek to do that and make that happen,” Vollmer said in the deposition. Kroft said Vollmer has since been fired from the company.

Although the news program had tried to secure an interview with Newsome, it was instead directed to talk with Levine. In an interview, Kroft presented Levine with a document “60 Minutes” received from a physician at one of the company’s Oklahoma hospitals that clearly showed an admission goal of 20%.

“That’s not from our company; I don’t know where that came from,” Levine said. “We don’t have any kind of goals. I don’t know what the percent admissions are in that hospital—maybe they’re actually 20%,” he continued. “But the admissions goal at any hospital is driven only by what the normal trend is for that hospital.”

Kroft said the news team heard of no complaints about quality at HMA facilities. He ended the segment by saying the Justice Department is investigating the hospital chain and has subpoenaed records pertaining to the management of its hospital emergency rooms admissions and software from ProMed Clinical Systems, which HMA has stopped using. The company is cooperating with the investigation, Kroft said. The company anticipated the negative report on Friday with an investor call.

By Jessica Zigmond

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