10 HCA hospitals under review for cardiac practices

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The hospital network HCA has evidence spanning 2002 to 2010 that some cardiologists in its Florida facilities could not justify decisions to perform procedures such as angioplasty and PCI, according to the New York Times. In an Aug. 6 investor conference call, company officials confirmed that they received a request from the U.S. Attorney’s Office for information on any reviews that assessed the necessity of cardiology services at its facilities.

The New York Times reported that a male traveling nurse had alerted HCA’s ethics office in 2008 to a stenting procedure in the cardiac cath lab at Lawnwood Regional Medical Center in Fort Pierce, Fla., that he deemed questionable. The nurse’s contract subsequently was not renewed. The New York Times went on to report that HCA proceeded with an investigation.

A review by an outside cardiac specialist of a sample of cases at the facility concluded that 13 or 17 cases performed by the interventional cardiologist under question were problematic, the New York Times reported.

HCA posted a statement on its website Aug. 6 in anticipation of the release of the New York Times article. “In its communications with us, The Times has given us examples where they assert that individual patients may have had adverse outcomes from the care they received at HCA affiliated facilities,” the company wrote. “While there were approximately 20 million visits to our facilities last year, we deeply regret any adverse occurrences to even one of our patients.”

In response to analysts’ questions during a conference call addressing financial results for second quarter of 2012, officials stated that the civil division of the U.S. Attorney’s Office in Miami had requested information in July on any reviews assessing the necessity of cardiac services at HCA facilities. The officials said HCA was trying to determine which hospitals had such reviews. Its preliminary investigation identified 10 hospitals, mostly in Florida.

When asked about its compliance programs, HCA officials responded that they have invested “big time” in a systemwide EHR to facilitate efficiency and compliance. They cited policies, procedures, training and monitoring systems designed to ensure compliance.

In its written statement preceding the Times article, HCA wrote that “physician-driven decisions have been and are the subject of much debate within the cardiology community. Accordingly, there is variation across the country, between regions, within regions, and even within the same medical staff or medical group regarding this issue. In addition, even when expert outside reviewers are engaged, they themselves may disagree on the same patient data. Thus, variation and disagreement among physicians indicates the difficulty in determining the medical necessity of these procedures.”

HCA, which stands for Hospital Corporation of America, is a for-profit chain with 163 hospitals and 110 free-standing surgical centers in 20 states and the U.K. It is based in Nashville, Tenn.