Hospital System & ED Staffing Company Accused of Fraud & Overbilling
Also: Canada EDs in serious trouble; how providers spend their time; police officer shot in the hospital; and celebrating independence
Top of the week
This past April, lawsuit related documents were released regarding a whistleblower case against TeamHealth and HCA Healthcare. Both were accused of fraudulent overcharging for medical care. Both have been sued for this before. Among the allegations was the direction for providers to use “powerplans” when ordering tests. It was not felt that the direction was for speed, efficiency, and compliance to clinical standards; but rather for increasing billable charges. The whistleblowers also cited increased pressure to see more patients each shift. The complaint also included how “excessive cost cutting” by HCA led to increased waiting room crowding. This article also talks about physicians being afraid to speak up about bad practices because they fear losing their jobs. Retaliation against whistleblowers is not new.
This time period in medicine is characterized by a number of challenges and conflicts. A number of hospital systems and staffing companies are in financial trouble and looking for ways to save money and maximize billable RVUs. Which provider has not heard employer led discussions about how to improve billable charges. To be clear, there’s nothing wrong with fair billing and fair collections for quality emergency management. How do employers achieve this without crossing ethical, legal lines and burning out their staff? Once you have physicians filing whistleblower complaints it would appear that the mark has been missed. If employers really wanted to address staff concerns, what should be done?
A popular intervention is an in-person or virtual townhall; but how effective are these? It’s not uncommon for eyerolling to occur when a townhall is announced. Could it be because staff feels townhalls are more ceremonial or a check-the-box action rather than a sincere, effective intervention? How many times have you participated in a staff town hall or employer-led anonymous survey, and the employer followed up on a quarterly basis addressing the list of staff members’ concerns? This is just one way for staff to believe their concerns are not only being heard, but considered and actioned when appropriate and feasible.
ED providers are the revenue producing engines of a staffing company. Burn out has taken hold and it continues. Staffing companies are looking for ways to stay afloat financially, but dissatisfied providers who leave jobs exacerbate staffing companies’ troubles. It would seem that if/when staffing companies truly put the provider and patient first, a staffing company model will prove sustainable. As long as providers feel squeezed and pushed to produce more revenue, they will experience near or sure burnout. They will leave jobs, and staffing companies will remain on shaky ground, or implode.
Emergency Medicine
Canadian EDs suffering due to in-patient crowding
This summer is posing a true crisis for Canadian EDs. American EDs are no strangers to admission holds. Of course, we know that in-patient nursing shortage directly leads to increased ED patient admission holds. However, Canadian EDs are also noticing that ED patient volume peaks are lasting longer than previously.
As we already know when ED providers have to manage patients in waiting rooms or hallways, stress increases and job satisfaction decreases. Check out two programs that have been initiated to support EM providers while they manage patients during overcrowded times.
House of Medicine
Not enough doctors or too many distractions?
Check out this quick read on how a physician’s time is distributed within our current operating conditions. This highlights a common provider’s complaint of spending the least amount of time with the patient, while we get consumed with other tasks.
Hospitals, health systems, and more
More news of financial troubles for hospitals
Hospitals are holding up to $12 billion in bad bonds. Now their lenders are mandating that hospitals come up with about $18 million in back up cash. If hospitals don’t comply, they risk credit downgrades and raised interest rates. Paying increased rates in temp/travel nursing costs was a contributor to their financial problems. How likely is it that they will now staff your ED with permanent, experienced nurses who are not yet burned out?
Indiana police officer shot dead in hospital near the ED
A domestic abuse patient presented to the ED for evaluation and treatment on July 3. She reported that her assailant was on his way to the hospital. A police officer attempted to intervene and arrest the assailant. The assailant shot and killed the police officer. This is so heartbreaking. However, I cant help but also think about the increasing threats ED staff face every day.
Three days ago, I responded to screams and yelling in the triage suite. A family in the waiting room was very upset about an expired family member who had been brought in by EMS. Family members snuck into a secured area of the ED. Some started to throw and damage items in a triage room. Then they became very verbally abusive and threatening to staff. Thankfully, security showed up, intervened, and no staff was harmed.
I know you can’t prevent every bad act, but hospital leaders have a duty to exhaust their efforts and means to protect staff. More must be done. If it isn’t, I can easily see the beginning of a series of lawsuits by staff charging that hospital administration did not do everything in their power to protect staff.
The Good Stuff
With 4th of July just behind us, I’m mindful that our great country celebrated its independence. Our country fought to establish its own identity as a nation, its own set of values, and a system of governing that gave the people greater voice and power. I am very thankful for this and hopeful that EM providers can have a greater say and impact in determining the fate of the workforce.
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