Tuesday, January 14, 2014
Former Health Management Associates CEO Gary Newsome has emerged as a defendant in a broad whistle-blower investigation alleging the Naples-based hospital system engaged in kickbacks to boost patient admissions, regardless of medical necessity.
In a news release Monday, the Department of Justice alleges Newsome directed corporate officers to exert “significant pressure” on emergency physicians and hospital administrators.
“The Department of Justice is committed to ensuring that health care providers who attempt to misuse federal health care programs for their own profit are held accountable,” said Stuart F. Delery, assistant attorney general for the Justice Department’s civil division, in a statement. “Schemes such as this one can contribute significantly to the rising cost of delivering health care and create needless patient risk.”
Newsome stepped down from his post in July to serve as as president of The Church of Jesus Christ of Latter-day Saints’ Uruguay-Montevideo Mission in South America.
HMA did not immediately respond to the government’s Monday afternoon announcement.
The company operates 71 hospitals in 15 states, including Lehigh Regional Medical Center, two Physicians Regional Medical Center hospitals in Naples and two health centers in Charlotte County.
The Justice Department has joined eight related lawsuits in recent months. It also accuses HMA of inflating billing claims to Medicare and Medicaid and paying other physician groups for referrals.
The Florida case accused the company of providing up to $800,000 worth of office space, equipment and other payments to Primary Care Associates of North Port in exchange for patient referrals to its hospitals. According to the suit, Primary Care Associates referrals accounted for one-third of revenues for both HMA hospitals in Charlotte County between 2004 and mid-2007, or more than $48 million.
HMA shareholders last week overwhelmingly voted to approve a $7.6 billion deal that would turn the company over to Tennessee-based Community Health Systems.
But there’s another unusual aspect to this clinic. Many of the patients will be paying for care out of their own pockets, thereby sidestepping the administrative overhead and pressures caused by health insurance.Zappos CEO Tony Hsieh’s effort to revitalize downtown Las Vegas includes last month’s launch of a new clinic, run by Iora Health and spearheaded by physician Zubin Damania. Stanford-trained, Damania also happens to rap by the name of ZDoggMD. So it’s no wonder the project has drawn attention.
A growing number of primary care doctors see this not only as a respite from their increasingly demoralizing work circumstances, but as a chance to do what they dreamed of in medical school. Research has long shown that good primary care is the cornerstone of a cost-effective healthcare system. In this type of setting, they can do more to help their patients—and without working to exhaustion or running up huge costs.
The patients pay for their care out of their own pockets with a modest ($60-80) monthly subscription fee. Annualized, that’s actually lower than many of today’s health plan deductibles. The doctors spend as much time with the patients as needed. They are even accessible 24/7 by phone and e-mail. In addition, each patient gets a personal health coach to help them improve their health. A coach may help diabetics learn to shop for food or help people with respiratory problems learn to allergy-proof their home.
Getting rid of insurance overhead alone cuts costs by as much as 40 percent. Letting the doctors take their time and concentrate on treatment and diagnosis also saves big money in the long run. Iora practices, and others like them, have reported savings in the 20 to 30 percent range so far.
One reason for that: The more time that primary care doctors spend with their patients, the fewer referrals to costly specialists they make, and fewer tests and procedures they need to order. Over the last ten years, the rate of referrals has skyrocketed as primary care doctors have been squeezed to do more in less time. In the 10-to-15-minute window insurance reimburses for, there is often little time to do more than type in a referral.
These newer types of clinics are a growing phenomenon in U.S. healthcare. They are referred to as concierge or direct primary care. The concierge practices are usually high-priced, cater to wealthy patients, and provide extra frills. But price-friendly, subscription-based primary care is now catching on. The number of such offices is growing at a rate of 25 percent per year, according to the American Academy of Private Physicians.
Some big-name investors seem to agree there’s promise in this approach. Hsieh recently invested in our company, Iora Health. Amazon’s Jeff Bezos was an early investor in one of our competitors, Qliance, as were Michael Dell and Drew Carey. We and others have attracted a growing number of venture capital investments as well.
Direct primary care is not just for the rich or middle class. In New York, we are partnering with Grameen PrimaCare to provide health care for members of Grameen America, a microfinance organization founded by Nobel Peace Laureate Muhammad Yunus. Together, we are building a clinic to open in mid-2014 that can meet the needs of even the poorest of New York’s working poor.
What’s driving this trend? Recent reports about insurance rate shock and big out-of-pocket expenses remind us that simply giving people access to health insurance doesn’t make them healthier. If they can’t afford the premiums or deductibles, they won’t get care. Company CEOs are particularly familiar with this problem. They want their employees to be healthy without breaking the bank. In a recent Gallup survey, 30 percent of adults reported skipping needed care because of costs.
Imagine spending as long as you need talking to your doctor about your health. What if your mother’s doctor called the hospital before she was admitted, stayed in close communication with them during her stay, and then saw her the day she was released to review her medications and treatment plan?
A provision in Obamacare even allows insurance companies to offer very low cost policies (wrap arounds) that complement this new enhanced primary care service. These policies only cover the type of specialized care you can’t get in your family doctor’s office as well as tests, hospital care, and medications, making them especially affordable. Will insurance companies see an advantage to offering such plans? Uptake nationally so far has been slow, but we are working with the Nevada Health Co-Op to offer just such a plan for the Las Vegas practice.
The self-pay primary care movement is currently small; only about half a million patients use such a practice today. But the patients who do use it report tremendous satisfaction. Direct primary care could be a big boon for middle-class patients caught between rising costs and shrinking paychecks.
For the working poor, however, such a model could be lifesaving. That’s why we plan eventually to build such clinics throughout the world. Imagine the U.S. exporting affordable care delivery to the rest of the globe? That would certainly get people’s attention.