Quote from HU_nurse
What's so bad about Tenet hospitals?
by Mary Watters
The picture of health? If you're talking about hospitals these days, the color is black, not rosy-red.
A frustrated Deb Rigiero, RN, who has logged 21 years at St. Vincent Hospital in Worcester, Mass., says that her Tenet
-owned hospital focuses on health - its financial health. Not only is she forced to speed up her nursing practice, she's required to cut corners at every turn. "They only want us to use one blanket per patient. They want us to use a bib instead of a towel because it costs more money to wash a towel then it does to wash a bib." (Wonder how much Tenet paid to figure that out?)
Scrimping on costs. Bringing in lower-wage techs. Understaffing units, meaning fewer RN salaries to dole out. RNs in the United States get daily snapshots of how finances are driving U.S. health care.
But with medical inflation rising faster than hot air and charges of fraud and financial missteps increasingly directed at hospitals, not to mention the 41 million uninsured, you want to see the big picture. Direct-care nurses wonder how their own hospitals might (or might not) contribute to these problems.
Now, thanks to a very big picture drawn by the Institute for Health and Socio-economic Policy (IHSP), in a study commissioned by the California Nurses Association, RNs can see dramatic evidence of the role hospitals - particularly for-profit chains - play in medical inflation and other maladies.
Drawing from a sample of 4,292 U.S. hospitals from Federal Hospital Cost Reports - the data hospitals are required to provide annually to the federal government if the hospital receives Medicare payments - the IHSP analyzed gross hospital charges as a percentage of their costs for Fiscal Year 2000-2001, current as of March 31, 2003. Gross charges are a key variable in determining reimbursements from payers. The results are startling, says Don DeMoro, a social scientist and researcher who is head of the Orinda, Calif.-based IHSP.
"For the first time, we can see a direct correlation between high hospital markups over costs and higher hospital profits," DeMoro says. "The nation's most expensive hospitals are making the most profits by marking up their gross charges an average of 525 percent over their costs. These profits, affect both the affordability and the quality of health care."
While the 100 hospitals with the highest average gross charges had the greatest average profits, the bottom 100 reported financial losses, on average.
Even more damning were the results linking corporatized medicine to high charges. Out of the top 100 hospitals with the highest charges and broadest charge-to-cost ratio, 95 were part of a hospital chain. Of those, 64 hospitals belonged to one health system - Tenet Healthcare Corp. In fact, the top 14 hospitals were all part of the Tenet system.
Of the nation's 100 lowest-charging hospitals identified in the study, 69 were not affiliated with a hospital chain.
The findings were in keeping with previous IHSP research on hospital mergers and acquisitions, U.S. pharmaceutical mergers and acquisitions, and the profits of hospitals and publicly traded health care-related corporations.
Looking at pricing strategies used by large hospital chains to inflate costs of hospital-provided prescription drugs, the IHSP considered the true costs of lowering hospital costs - reducing professional staff for lower-wage (and lower-skilled) workers, while forcing corporatized efficiency programs upon the art of healing. The IHSP assessed the way other health care sectors, like pharmaceutical firms and medical device manufacturers, behaved in the marketplace. It drew a grim conclusion.
"The United States does not have a health care system. It does have a market-driven - and market-concentrated - health care industry."
Guilty as Charged
The IHSP's data of charges as a percentage of costs is calculated from hospitals' own self-reported numbers sub-mitted to the federal government's Centers for Medicare and Medicaid Services and detailed in federal Hospital Cost Reports. The more than 28 million hospital patient discharges represented in the data encompass all DRGs or diagnostic related groups, the industry standard used to describe procedures that make up the charges for a hospital stay, such as appendectomies and hernia repairs. The federal Hospital Cost Reports detail hospital gross charges and actual costs for hospitals' operating rooms, recovery rooms, ERs and ICUs, coronary care units, cardiac catheterization labs, plus medical supplies and pharmaceuticals charged to patients and many other charges.
"We expected to see a number of hospitals from big for-profit chains on our list of the 100 most expensive hospitals," says DeMoro, "but we didn't expect to see quite that volume. The data made clear that corporate hospital systems have significantly higher charges than the non-profits."...
...Not surprisingly, Tenet was one of the most expensive hospital chains, based on its nationwide charge-to-cost ratios. Tenet hospitals, on average, had charges that were 476.6 percent of costs, or almost five times the cost of the service. The giant Tenet system was eclipsed only by tiny Crozer-Keystone Health System, a "system" of two hospitals, with a 584.36 percent charge-to-cost ratio. Third on the list was St. Barnabas Health System, which has gross charges averaging 419.63 percent of cost....
Tenet's outsized hospital charges have particular significance, considering that a hospital can increase Medicare reimbursements through its charges. The corporation's outlier payments rose from $351 million in 2000 to $763 million in 2001. Indications that Tenet found a way to game the Medicare system to increase its outlier payments have resulted in a federal investigation ... and a resulting drop in share price. ...
...The IHSP report zeroed in on a high-dollar cardiac DRG procedure within the Tenet system as reported by Tenet to the California Office of Statewide Health Planning and Development. DRG #104 - Cardiac Valve and other Major Cardiothoracic Procedures with Catherization - occurred 3,331 times for Medicare patients in California. Tenet's statewide median charge for that DRG is $229,962, while the statewide median is half that or $113,671. For a non-Medicare patient, the statewide median charge for the same DRG is lower, at $104,205. Tenet's median charge for non-Medicare patients in California is $205,675. Last fall, a huge scandal was uncovered at Tenet's Redding facility, where patients were needlessly put at risk when surgeons performed dangerous (and unnecessary) heart procedures to increase Medicare reimbursements....
...According to its Web site, Tenet has moved to a kinder, gentler policy with its uninsured clientele. The corporation now says that it will offer discounted pricing equivalent to the hospital's current managed care rates for uninsured patients, for which Tenet is seeking regulatory approval, and will not have hospitals seek to place liens on homes as legal action for non-payment.
Although the corporation is now experiencing financial problems, Tenet has sported a healthy balance sheet and well-paid management while slashing staff and services. Tenet Healthcare profits for the fiscal year ending May 31, 2002, were $785 million. Profits from 1990 through FY ending May 31, 2002, were reported as $2.9 billion, according to the IHSP. ...
..."Tenet is looking at the bottom line. They're looking at productivity," says Deb Rigiero, the RN at St. Vincent Hospital in Worcester, Mass. "I feel like I work on an assembly line. You get used to a certain speed and think you're doing a good job, and then they speed it up a bit, and you get used to that speed, and then they speed it up even more, and finally you just can't do a good job. Finally, the product is bad, but we can't give a good product because we're going too fast. Then they blame the nurses."
Sandy Ellis, a psychiatric nurse, will have logged 11 years with St. Vincent this August. She, too, saw changes with Tenet's entrance.
"We had started to see a dramatic decrease in services for patients. The nurse-to-patient ratios in med/surg unit were increasing from four to seven to eight to nine," Ellis says. "I started to see a dramatic increase in RN staffing ratios. This was prior to our union contract. I'm a psychiatric nurse, and I saw a change in physical care. Nurses had less time with patients to educate them. Coping groups and therapy groups were cut.
"In the last three months since Tenet has been facing a financial crunch, we've seen an increase of nurses floating. Nurses have been asked to take days off with out pay. These things are within the union contract, but there has been an increase in infractions of staffing guidelines. There has been a sharp decrease in working conditions - and this is directly tied to the care of patients."
..."What's appalling is that more people aren't outraged," says Philbrook. "There's no oversight on the process and how people suffer. Executives make over a million dollars then deny us coverage."
Rigiero fumes, "There's not a patient in the country who is getting his money's worth. There is too much money not going to patient care. It's dangerous to be sick. If I had a family member who was admitted to a hospital, I'd stay at the bedside. Nurses are too busy."...
...We expected a backlash. We expected the highest charging facilities within the hospital industry to come out swinging," says DeMoro, "but no one seriously questioned the methodology. Tenet representatives weren't pleased and made comments. But no one disputed the results or how we arrived at them."
Ellis is happy about the exposure that the report is getting. "I'm glad people are finding out where the money goes," she says. "Patients are at their most vulnerable when they are in a hospital. It's an absolute crime in my mind that anyone is making a profit on the backs of patients or health care workers.
"Nurses don't think about these issues every day. We think about not having enough time to do everything we need to do for our patients, and this is our greatest heartache."