UPDATE: June 22, 2023: HCA has responded more fully to allegations it inappropriately transfers patients to hospice centers to reduce its mortality rates.
In a statement, HCA’s director of media relations Harlow Sumerford called the SEIU’s report “not serious” and “propaganda filled with misleading and absurd accusations that are not supported by facts.”
“It is simply untrue and wrong to suggest that medical care in HCA Healthcare hospitals is based on anything other than a physician’s independent medical judgement of what is in the best interest of a patient,” Sumerford said. “The SEIU has a distorted view of healthcare and seems to not understand that providing quality care and saving lives is a good thing.”
Dive Brief:
- SEIU, the largest healthcare workers union in the U.S., is accusing for-profit hospital giant HCA of inappropriately transferring patients to hospice centers to reduce its mortality rate, thereby boosting profits and executive compensation.
- The union’s report is partially based on an analysis of Medicare claims data, which found HCA hospitals have a higher average rate of patient transfers to hospice than the national average, and the system’s transfer rates are increasing. At the same time, HCA’s in-hospital mortality rates have been below the national average over the past few years and have grown more slowly than the national average.
- SEIU said the findings raise questions about potential corporate interference to decrease the number of patients who die in HCA hospitals, and urged both HCA and regulators to investigate. An HCA spokesperson suggested the report was meritless in response.
Dive Insight:
HCA is one of the biggest hospital operators in the U.S., with 180 hospitals and about 2,300 ambulatory care sites in 20 states and the United Kingdom. Like other hospital chains, HCA has faced recent accusations of prioritizing profits over patient care, as public criticism of practices like understaffing rises.
Now the system is facing allegations it could be inappropriately sending patients to hospice care — meant for people in the last phases of terminal conditions — to boost executive compensation and its bottom line. The SEIU’s report relies on Medicare fee-for-service claims data, unsafe patient discharge citations from the CMS and other public data.
The Medicare analysis found HCA’s average hospice transfer rate from its hospitals jumped more than 50% between 2017 and 2021. By 2021, the hospital operator had a hospice transfer rate nearly 40% higher than the national average, according to the report.
The rate of patients who died on the same day they were transferred to hospice from HCA hospitals also increased over that period, from 7% in 2017 to 18% in 2021 — more than double the national average, SEIU said.
The union said the findings are troubling in light of HCA’s executive compensation packages. HCA’s senior officers, including CEO Sam Hazen, are paid bonuses based in part on on quality and patient care metrics, according to company Securities and Exchange Commission filings.
One of those metrics is the mortality index, which is partially calculated based on in-hospital deaths — and excludes post-discharge deaths, which would include hospice transfers, SEIU argued. That could create incentives for increased rates of discharges to settings where patient deaths wouldn’t be counted against compensation targets, the union said.
The report also relies on a 2018 lawsuit filed by a former HCA surgery chief alleging he was pressured to transfer patients to hospice who were no longer profitable. That lawsuit was later voluntarily dismissed by the plaintiff after the government decided not to intervene.
“Decisions about treatment for seriously ill patients should never be made based on profits,” SEIU President Mary Kay Henry said in a statement. “That HCA might also be boosting profits and executive compensation with questionable hospice practices is beyond troubling.”
HCA reported profits of almost $7 billion in 2021 and $5.6 billion in 2022.
The Nashville-based system and SEIU have a long history of clashes, mostly over staffing levels. The union has released reports finding staffing levels at HCA facilities are 30% below the U.S. average and accusing HCA of questionable emergency room admission policies.
Earlier this year, the union reached an agreement with HCA leadership to avoid a 3,000 worker strike that would have affected five hospitals in California.
