Specialty hospitals, doing only high-profit procedures -including even surgeries- endanger their patients by not provide staff or infrastructure to deal with medical emergencies. This NY Times story describes a Texas specialty hospital that called 911 to save a spinal surgery patient, who then died at a full-service hospital.
Of course, the growth of specialty hospitals for inpatient care is the mirror image of the growth of stand-alone doc-in-a-box operations in shopping centers and drug stores, for primary care.
(1) States like Massachusetts create “universal healthcare” by legislating individual mandates requiring even the poor to buy private insurance.
(2) Then insurers promote barely-affordable policies that are worthless because patients must personally pay thousands of dollars for healthcare before the insurance kicks in, and
(3) Then medical companies promote less expensive doc-in-a-box operations for the insured who are still paying for their own care, but these stand-alone places have no access to patient’s medical records, clinical labs, or other aspects of real primary care. 98,000 people a year already die from medical mistakes, largely due to fragmented medical care, the left hand not knowing what the right hand is doing.
So the “unseen hand of the market” turns out to be deadly collusion between business and government.
n California, Governor Schwarzenegger, Senator Perata, and Representative Nunez are negotiating to reach a compromise health reform bill they can present together to the legislature. Considering that two of the three players propose individual mandates, this compromise bill is likely to be pretty bad. What will our response be?
Some Hospitals Call 911 to Save Their Patients
By REED ABELSON
New York Times, April 2, 2007
Should a hospital be able to handle a medical emergency?
The answer may seem self-evident. But patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance.
That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later.
The episode occurred at a small hospital that is owned and run by doctors — one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements.
These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals.
Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals.
But the Texas case, and others like it, have invited new scrutiny from regulators and members of Congress about these hospitals’ ability to care for patients who suffer complications after their operations.
While some of these hospitals are large sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. For example, small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient’s recovery.
A similar case involved an 88-year-old woman two years ago at a small doctor-owned hospital in Portland, Ore., where the nurses called 911 after she was given too much pain medicine following spine surgery. She, too, later died.
As the number of doctor-owned surgical hospitals grows, federal and state officials now acknowledge that the government rules may be too vague about the emergency abilities a hospital must have in place. Regulators are particularly concerned about the very small hospitals that focus on only a few kinds of surgery but perform operations that frequently require an overnight stay. While Medicare’s rules currently say a hospital must “meet the emergency needs of patients in accordance with acceptable standards of practice,” the details are left largely to the hospital’s discretion. Federal and state officials say they are now reviewing the guidelines to toughen the rules and make them more specific.
“We’re concerned about good quality of care in any or all settings,” said Thomas E. Hamilton, who oversees hospital certification for the federal Centers for Medicare and Medicaid Services.
Medicare recently terminated its agreement with the facility involved in the Texas case, West Texas Hospital, a 14-bed hospital in Abilene that performed procedures ranging from plastic surgery to complex spine operations.
That is where Mr. Spivey had spine surgery.
Sometime during the night following his surgery, the staff grew alarmed by his breathing difficulties and called the surgeon back to the hospital. Ill-equipped to handle a medical emergency, the West Texas staff phoned 911, said Darrell Keith, the lawyer who is representing Mr. Spivey’s family and is still investigating what happened.
When the paramedics arrived, they inserted a breathing tube before taking him to a nearby full-service hospital where he was pronounced dead a short time later.
“It is horrific that Steve Spivey had to sacrifice his life in order to expose the problems associated with physician-owned hospitals,” Mr. Keith said.
West Texas, citing patient privacy, said it could not comment, although it defended the quality of its care.
After a review of the hospital following Mr. Spivey’s death, federal officials decided last month that the hospital could no longer continue treating patients covered under the government’s Medicare program. Although the chief executive of West Texas Hospital defended its practices, he said it would not appeal the government’s decision. The hospital has since closed.
The doctors who set up the specialized hospitals defend them by saying that by running the centers themselves and concentrating only on certain procedures, they can provide the best results for patients.
“This is really about the physicians getting back in control,” said Greg Weiss, chairman of USMD Hospital, a small physician-owned hospital in Arlington, Tex. USMD, which has 18 beds, has an emergency department and a doctor present around the clock, and is also building an intensive-care unit, Mr. Weiss said.
Proponents of the specialty hospitals say the Abilene and Portland cases are aberrations that critics are exploiting to defend the turf of full-service hospitals. They say they are able to handle their patients’ medical emergencies, whether or not they have emergency departments.
But some members of Congress are now pushing Medicare to take a closer look at how such hospitals are regulated.
“The problem with physician-owned specialty hospitals is that decision-making is more likely to be driven by financial interest rather than patient interest,” said Senator Charles E. Grassley, Republican of Iowa, who is a longtime critic of such hospitals.
“You see it in the cherry-picking of patients, and with policies that instruct hospital staff to call 911 for the local community hospital if emergency care is needed,” said Mr. Grassley, a ranking member of the Senate Committee on Finance, which oversees Medicare.
Supporting his effort is the committee’s chairman, Senator Max Baucus, Democrat of Montana, and Representative Pete Stark, Democrat of California, who leads the subcommittee on health for the House Committee on Ways and Means.
Congress in 2003 temporarily banned new construction of specialty hospitals over concern that they were draining profit away from the full-service hospitals. The moratorium ended in 2005. Congress has asked for various reports on the issue, including a comprehensive analysis last year by the federal Department of Health and Human Services. The number of these hospitals, around 100 at the time of the moratorium, have steadily climbed to nearly 140 today, with more than two dozen under construction.
Mr. Hamilton, the Medicare official, says the agency is now reviewing whether its rules need to spell out exactly what emergency procedures a hospital is required to have in place, and whether hospitals must disclose any limitations to patients. Some types of hospitals may merit greater attention and oversight than others, depending on the nature of the operations they perform, he said, and “size may be a factor.”
Because some of the hospitals are so small, they may not have the systems in place to handle an emergency.
“It almost assumes no one is going to get sick,” said Dr. Mark V. Williams, a professor of medicine at Emory University. Without a doctor on premises, a nurse must call a physician for help if there is an emergency, he said, but there is evidence that nurses are often reluctant to do that.
According to Medicare’s review of state records, West Texas Hospital had called 911 for an ambulance 15 times to transfer patients during medical emergencies since it opened in May 2005.
The hospital says that some of those calls may have involved routine transfers of patients to other hospitals.
Some proponents of doctor-owned hospitals defend calling 911. It is “by no means an uncommon practice,” said Molly Gutierrez, executive director of Physician Hospitals of America, which represents many doctor-owned hospitals.
Although stabilizing a patient is essential for any hospital, she said, hospitals of all kinds and sizes frequently rely on emergency services to transport patients to other medical centers.
But among full-service hospitals, such routine transfers are carefully coordinated, according to Carmela Coyle, senior vice president for policy with the American Hospital Association, which represents full-service medical centers.
“The difference is, a community hospital plans for the unpredictable,” she said. Medicare does require all hospitals to meet certain general standards, relying on the states or an independent national accrediting body called the Joint Commission to make sure hospitals meet the requirements.
Beyond any changes Medicare might make, some states are also contemplating new rules. Texas, for example, is considering requiring any hospital in a county with 100,000 or more residents to have a doctor on the premises around the clock and to have certain emergency medical equipment on hand. Indiana and Kansas are also contemplating similar changes.
For more news on specialty hospitals, click HERE.