Profits Over Patients: Here Come the Roaches!

America’s largest hospital company has been putting patients at risk.

To increase profits, they have cut their staff and shrunk maintenance budgets, resulting in higher occurrences of sentinel events, including patient deaths. Both doctors and nurses have complained about the situation, but there seems to be a disconnect between the clinical staff and the leadership. In fact, hospital critics have been reprimanded. Money that could be used to fix the problems is allocated to bed capacity increases which boost revenue.

Video Spotlights:     Are Hospitals Prioritizing Profits Over Patients (January 13, 2023, WSLS 10)

HCA neurosurgeon says lives ‘absolutely’ have been lost due to hospital chain’s behavior (February 15,2022, NBC News)

This post is based on the NBC News article, Roaches in the Operating Room: Doctors at HCA Hospital in Florida Say Patient Care Has Suffered from Cost Cutting, by G. Morgenson, A. Schecter, and C. McFadden, February 15, 2023, and the YouTube videos in the Spotlight. Image sources: Alvaro German Vilela/Shutterstock and Ananaline/Shuttertsock.

Discussion Questions:

1. What is value? How can it be improved? How did the Bayonet Point hospital fail to do so?

Guidance: Value is quality/cost. In healthcare, it is expressed as health outcome per dollar spent. To increase value, quality has to increase, cost has to decrease, or even better, both have to occur at the same time. At this hospital, they seem to have cut costs at the expense of quality. Although they cut their own costs, it is unclear whether they even passed the savings onto the payers (CMS, insurers, and patients).

2. How could the hospital improve quality and lower costs concurrently?

Guidance: Review the cumulative model and emphasize how targeting quality first is required to excel on the other competitive priorities (cost, delivery, and flexibility). By putting patient safety and quality of care first, the hospital would reduce the incidence of preventable medical errors and litigation costs. Also, it would not have to use scarce resources for rework (e.g., readmissions). It will not happen the other way around. Slashing costs first means cutting corners at the expense of quality. Another incentive to focus on quality first is the value-based purchasing program which rewards hospitals for quality improvements and penalizes them for poor health outcomes and unsatisfactory patient experience. Therefore, the hospital could increase its reimbursements by making quality its top priority.

3. The hospital’s spokesperson boasts new construction and expansion as signs of commitment to quality. What do you think of her arguments?

Guidance: To be fair, the Bayonet spokesperson also mentions clinical unit updates and maintenance upgrades. However, the investments do prioritize major increases in bed capacity. The problem is that the expansion is going to stretch scarce human resources further. At Bayonet, the anesthesiology staff has been reduced to such a point that serious errors have occurred. Furthermore, the low nurse-to-patient ratio has endangered patient safety, as evidenced by a patient’s death due to lack of monitoring for a 12-hour period. According to federal data, full-time staff was reduced by 37% at another HCA hospital in North Carolina (see first video), forcing existing employees to multitask and neglect patient care. Therefore, the spokesperson’s comments distract rather than address the root causes of the problems.