New Jersey calls public well being emergency amid omicron hospital surge

New Jersey Gov. Phil Murphy speaks to volunteers as he meets with Newark Mayor Ras Baraka during the gubernatorial election in Newark, New Jersey November 2, 2021.

Eduardo Munoz | Reuters

Phil Murphy, Governor of New Jersey reinstated a public health emergency Tuesday as hospitals struggle to keep up with an influx of patients as Covid cases surge amid a persistent shortage of medical staff.

The recent spike is being fueled by the rise of the rapidly spreading Omicron variant, which the Centers for Disease Control and Prevention has in its possession These account for about 95% of the sequenced Covid-19 cases in the US Although vaccines, and especially booster doses, provide statistical protection against serious illness and death, experts say the sheer volume of cases is overwhelming hospitals.

Murphy said the state is seeing nearly 35,000 new Covid cases a day and more than 10,000 residents have been hospitalized in the past two weeks.

The re-declaration allows the governor to exercise certain emergency powers, including mask mandates in schools.

Murphy said the renewed state of emergency will have “no new impact at all” on local residents’ daily lives.

“That’s what it doesn’t mean,” he said. “It doesn’t mean new universal mandates or passports. It means no bans. It means no business restrictions or collection limits.”

Half of the hospital beds at Newark University Hospital are filled with patients who have been diagnosed with Covid-19, some of whom were admitted for something else but subsequently tested positive, said hospital president Dr. Shereef Elnahal in an interview on CNBC’s “Squawk box” On Wednesday.

But Elnahal said the Covid infection itself is not his main concern.

“Actually, I’m more worried about a health issue than a Covid-19 issue,” Elnahal told CNBC Becky Swift. “Right now we see our workforce demoralized. There is no light at the end of the tunnel to paint now like I did in Spring 2020.”

He said the industry is losing talented clinicians between the ages of 45 and 60, “often the most energetic and knowledgeable people in the hospital.” That’s a problem that may actually outlast omicron, “which appears to have already plateaued, at least in cases in the New York metro area.”

Elnahal said nearly 10% of his hospital’s staff are traveling with Covid, bringing the hospital closer to a staff crisis with “awkward” staff-to-patient ratios.

Elnahal said he would like the government to come up with a “clear definition” of the endgame in relation to Covid-19.

“Which case level defines the endemic case?” What does this mean for healthcare regulations and what can we do, what should we avoid? How much capacity should we create? What is the guidance for healthcare organizations that will be dealing with this pandemic but also with the aftermath?” are some of the questions he wants answered.

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WATCH: University Hospital CEO on Covid staff crisis: Our workforce is demoralized

State lawmakers urge Ohio Medicaid director to designate Summa Well being a ‘distressed hospital’ and supply cash for hiring extra workers

CLEVELAND, Ohio – A group of state lawmakers sent a letter on Wednesday asking the Ohio Department of Medicaid for more resources for Summa Health to hire more nurses to alleviate care bottlenecks caused by a surge in coronavirus cases Omicron variant were caused.

The letter to Ohio Medicaid director Maureen Corcoran said Summa Health, which operates two hospitals in Akron and Barberton, should be viewed as a “distressed hospital” eligible for more state and federal aid to help more nurses to adjust. The hospital system manages nearly 60% of all emergency rooms in Summit, Stark, Portage, and Medina counties.

The eleven lawmakers, seven Republicans and four Democrats, urged Corcoran to allocate money from the US dollars passed by lawmakers that year to help coronavirus.

“The Summa health system is in a state of crisis,” the letter said. “We urge you to use the resources that we supported in HB 169 to create the necessary state labor incentives so that our region can cope with this crisis.”

Summa Health President and CEO Cliff Deveny said he was aware of the letter and was in regular contact with four counties’ lawmakers and state officials. The strain on Summa Health’s ability to care for patients – both with and without coronavirus – has been caused by two main factors.

“It really is a function of the exposure to the number of COVID patients,” he said. “They stay about twice as long as a typical patient, so they use up a lot more resources. Since everyone has a problem with staffing, we spend a lot more on bonuses, overtime and temporary work. “

In the letter from the legislature, the fluctuation rate in the care sector was highlighted, which is almost 15.6% and is thus well above the fluctuation rate of 9.4% in 2019 before the start of the pandemic.

HB 169 provided US $ 124 million for “hospitals with critical access, rural hospitals, or hospitals in distress,” according to Corcoran. Summa Health manages more than 68% of all inpatient care for Medicaid recipients in the four counties.

The hospital system is also so overloaded that 30% of inpatient beds are occupied by coronavirus patients. The hospital system paused dialing operations December 6, redirecting its staff to emergency, surgical and critical care. Emergency room patients wait an average of 48 hours before bed.

According to the letter, the hospital system also manages 35% of positive coronavirus cases in hospitals across the region, 49% of patients in intensive care units, and 58% of patients who require a ventilator.

“You are essentially at a turning point,” said US State Representative Casey Weinstein, a Hudson Democrat. “It’s a combination of a surge in COVID patients, the vast majority of whom are unvaccinated, which honestly means that I am close to tending to my constituents.”

State Rep. Bill Roemer, a Republican from Richfield, said he hoped the letter would convince Corcoran to send additional money to offset Summa’s cost of hiring temporary nurses.

“We need the right funding,” he said. “Summa spends $ 180 an hour on visiting nurses. That’s the problem. We want to make sure that we can attract, retain, and adequately pay the current workforce we have so that we can address the problem. “

Deveny didn’t speculate on what could happen without help, but said Summa would expect even more hospitalizations, the peaks of which tend to lag behind the daily case numbers. The state reported more than 12,800 newly confirmed coronavirus cases on Wednesday, beating the daily record of 12,500 set on Tuesday. The hospital brought refrigerated trucks in case they needed extra space in the morgue.

“We are anticipating a larger wave of patients than we have now,” said Deveny.

Cleveland.com/The Plain Dealer has contacted Corcoran and the Department of Medicaid for comment.

Read the letter:

Continue reading:

What’s driving the surge that has made Cuyahoga and neighboring counties the worst for rising COVID-19 cases?

“Overwhelmed” and “Exhausted” ERs – Cleveland Clinic University Hospitals provide an insight into the state of hospitals during the COVID-19 surge

How easy is it to find COVID-19 tests to use at home? Holidays are expected to increase the demand for home testing

UNC Well being Superior Care at Residence shortens hospital stays, saves cash :: WRAL.com

– A new program from UNC Health enables many patients to leave the hospital earlier than possible and receive acute care at home. It is a program that will save the patient money and open up the much needed bed space in the hospital.

Local UNC TV legend Roy Underhill was recently a patient who benefited from the new program. His television show “The WoodWright Shop” is still on public television channels across the country.

“[It was] for 37 years. It’s one of the longest-running television programs, “said Underhill, who also teaches students how to use traditional woodworking tools as opposed to power tools.

His students come to his woodcarving school in Pittsboro, some from outside the United States. “In a next class we have a student from Norway who has seen all the shows,” said Underhill.

Less than a month ago, kidney infection robbed the 70-year-old of his strength. “It’s known as sepsis and is fatal,” Underhill said.

He was in the UNC emergency room 24 hours and spent another three days in acute care. However, Underhill was presented with a new option. He describes it this way: “They had a new program and they said I could be home and they would bring me hospital care!”

It’s called Advanced Care at Home, and it includes a home health monitoring system, backup power supplies and communication devices via a phone, and video via an iPad or even a button on a wristband.

“And so they actually see someone six to seven times a day, either virtually or in person,” said Ila Mapp, the program’s administrative director at UNC Health.

She says national data shows that patients recover more quickly on the program. “It allows patients to be more comfortable and in more control,” Mapp said.

She adds, “It’s the patients who aren’t quite sick enough to go to the hospital but can go home and still get the acute care they need.”

She says patients who receive home care are also less likely to get other hospital infections like MRSA or even COVID-19.

Underhill quickly accepted the home care offer. He said, “You wear your own clothes, you are in your own bed and only get the medication you need.”

Underhill points out that it’s also cheaper than staying in the hospital. “Releasing a hospital bed saves money, you get better faster. What’s not to like,” he said.

He’s also excited to be back in his own home as well as his wood construction school, sharing his old woodworking talents with eager students.

More on this

Former President Invoice Clinton admitted to hospital with non-Covid an infection

Former President Bill Clinton

Adam Jeffery | CNBC

Former President Bill Clinton was hospitalized Tuesday night for treatment for a non-Covid-related infection, according to his spokesman.

Clinton’s spokesman Angel Urena said late Tuesday the former president had been admitted to UC Irvine Medical Center in California.

“He is on the mend, in a good mood and is incredibly grateful to the doctors, nurses and staff who take excellent care of him,” Urena said in a statement.

Clinton’s doctors said in a joint statement that he was hospitalized for “close monitoring” and given intravenous antibiotics and fluids.

“He will remain in the hospital for continuous monitoring,” said his doctors Alpesh Amin and Lisa Bardack. “After two days of treatment, his white blood cell count drops and he responds well to antibiotics.”

They said the California-based medical team is in “constant communication” with the president’s New York-based team, including his cardiologist.

“We hope he goes home soon,” the statement said.

Clinton, who is 75 years old, had a history of heart problems. In 2004 he underwent four cardiac bypass operations to relieve heavily clogged arteries. according to NBC news. In 2010, he had another heart surgery that involved inserting two stents into a coronary artery.

Children elevate cash for hospital staff who look after COVID-19 sufferers

A family of four from the city of Atlantis, South Florida – who had and won a battle against COVID-19 – are paying it on. The Baudo family were moved by how hard healthcare workers work to comfort COVID-19 patients. They decided to donate money from their homemade lemonade stand to Bethesda Hospital East in Boynton Beach. Sophie Baudo (10) and Anniina Makila (9) are professionals in running lemonade stands with the idea of ​​selling lemonade, “said Baudo. Baudo and Makila are best friends.” When we were little, we decided to be partners in sales to be, “Makila said safely under there, very safe, unbreakable and fireproof,” said Jack Baudo. Idalia Baudo said she and her entire family had COVID-19. “It just hit us, there were no symptoms or anything,” said Idalia Baudo. “It was just – boom – and then we were out.” She is proud that her children give something back. “I couldn’t be more moved that you have the compassion,” said Idalia Baudo. “This is something I always pray for that they have some sensitivity to be in tune with.” Hospital officials appreciate the support they are inspired to be a future fundraiser, “said Barbara James of the Bethesda Hospital Foundation.

A family of four from the city of Atlantis, South Florida – who had and won a fight against COVID-19 – continues to pay.

The Baudo family were so moved by how hard the health care workers work to comfort COVID-19 patients that they decided to donate the money raised from their homemade lemonade stand to Bethesda Hospital East in Boynton Beach.

Sophie Baudo, 10, and Anniina Makila, 9, are professionals in running lemonade stands.

“It started about a year ago when I first came up with the idea of ​​selling lemonade,” said Baudo.

Baudo and Makila are best friends.

“When we were little, we made the decision to become a partner in sales,” said Makila.

Sophie’s brother Jack Baudo, 8, collects the money.

“There’s a safe underneath, very safe, unbreakable and fire-proof,” says Jack Baudo.

Idalia Baudo said she and her entire family had COVID-19.

“It just hit us, there were no symptoms or anything,” said Idalia Baudo. “It was just – boom – and then we were out.”

She takes pride in the fact that her children give something back.

“I couldn’t be more moved that you have the compassion,” said Idalia Baudo. “This is something I always pray for that they have some sensitivity to be in tune with other people.”

The hospital management appreciates the support.

“I thought I’d come out and give them a little love and hopefully one of them will be inspired to do a future fundraiser,” said Barbara James of the Bethesda Hospital Foundation.

Vermont well being program decreased hospital stays, saved cash

The first two years of a Vermont program designed to keep patients healthy while cutting costs saved Medicare patients money and kept more people out of the hospital, an evaluation of the program found.

Commissioned by the Centers for Medicaid and Medicare Services and released this week, the report looked at the first two years of Medicare’s participation in Vermont’s so-called all-payer model of health care.

the report found that in 2018 and 2019, Medicare patient costs were saved about 4.7% year over year in the system under study. For all Medicare patients in Vermont, the system saved about 6.5% year over year.

In 2019, the system reduced the acute hospital stays of people in the system by almost 18%, it reduced the acute treatment days of patients in the hospital by 14.7% and the number of people re-admitted to hospital within 30 days by 12, 4%.

“These declines are very encouraging,” said Ena Backus, director of health care reform in Vermont, on Friday.

The same report found that the project run by the OneCare Vermont organization did not enroll as many people to join the system as hoped. In 2019, it was hoped the program would cover 75% of eligible Medicare patients, but it only hit 47%.

Vicki Loner, CEO of OneCare, said the overall results are encouraging.

“We still have a long way to go to fully realize the (all-payer) vision, but we are on the right track and we must continue to make steady progress for the people of Vermont.”

The report covers 2018 and 2019, the first two years of the five-year program.

The goal of the total pay model is to maintain patient health while reducing healthcare costs by paying a fixed amount of money for each insured patient rather than for every service provided.

To achieve this goal, medical providers, and in some cases social workers, work closely with patients to ensure they are receiving the best possible care.

The report commissioned by CMS from an organization affiliated with the University of Chicago looked only at the Medicare population of Vermont participating in the all-payer model. It also looked at the impact of the system on Vermont’s Medicare program as a whole.

Medicare is the state health insurance for people over the age of 65.

According to the report, the system provides an important, unifying forum for providers, payers and the state to work towards health reform.

“The widespread transformation of long-term care will take time,” the report says.

OneCare also works with Medicaid, an insurance company for low-income Americans, and some of the patients privately insured through the Blue Cross Blue Shield of Vermont.

Future reports will look at the performance of both Medicaid and private insurance companies, Backus said.

The five-year program is slated to run through 2022, but Backus said Vermont officials will request an extension of the program to 2023 by the end of this year.

Earlier this year, Vermont auditor Doug Hoffer released a report that found OneCare missed its Medicaid financial targets by $ 25.6 million between 2017 and 2019.

The Untamed Rise Of Hospital Monopolies : Planet Cash : NPR

Hospitals are getting bigger and more expensive

Last month, Michigan’s two largest hospital systems, Spectrum Health and Beaumont Health, announced that they were planning to become one. The $ 12.9 billion megamerger would create a healthcare industry complex with 22 hospitals, 305 outpatient facilities, and an insurance company. It would employ 64,000 people, making it Michigan’s largest employer. Local newspapers had expected the merger to “sail through” government approval. But now they are not so sure.

This is because President Biden recently signed an executive order stating that his government is serious about promoting competition and specifically identified hospitals as an area where increasing monopoly is a problem. The order, says the White House, “Emphasizes that hospital fusions can be harmful to patients and encourages the Department of Justice and the Federal Trade Commission (FTC) to review and revise their merger guidelines to ensure that such fusions do not harm patients.”

Hospitals are a really important part of the American economy. Not just in terms of health and wellbeing, but also in terms of dollars and cents. Most of America’s healthcare spending goes to hospitals. And the hospital sector is one of the largest sectors in the entire American economy, accounting for about 6 percent of American GDP. Hospitals do a lot of good. You save lives. They create good jobs. But with their increasing monopoly, Zack Cooper, an economist at the Yale School of Public Health, fears they will become like a “Dracula” who “sucks some of the vibrancy in many cities across the country.”

Cooper and colleague Martin Gaynor found the numbers on hospitals using the government’s preferred method of measuring market concentration and found that approx. 80% the American hospital markets are now “highly concentrated”. “The average hospital market in the US is well above what the FTC and DOJ would consider healthy levels of concentration,” says Cooper. Many of these markets, he says, are dominated by just one or two hospitals, which gives them the market power to withdraw extra money from communities for health procedures and emergencies.

In addition to decades of mergers and acquisitions with hospitals that are devouring other hospitals, hospitals are also increasingly buying up medical practices. Economists refer to this as “vertical integration”. Think of steel manufacturers who buy the railroad lines. As with mergers and acquisitions, Cooper said, many of these deals have not been properly scrutinized by federal regulators.

According to Cooper, the research clearly shows that increasing monopoly has increased prices for patients. Less competition means hospitals can charge higher prices and get away with it. You can pay lower wages and get away with it. And they can offer worse care and get away with it. “We want companies to compete and be incentivized to upgrade their quality to attract more consumers, and the more hospitals merge, the less harsh those incentives become,” says Cooper. “We have evidence that death rates are literal higher in markets where hospitals have less competition. “

[Editor’s note: This is an excerpt of Planet Money‘s newsletter. You can sign up here]

The bizarre thing about all of this is that many of these monopoly hospitals are technically considered “non-profit”. Apparently, there are “a lot of nonprofits in the healthcare industry,” jokes Cooper. He doesn’t take their “charitable” status very seriously. He sees it more like a game where nonprofit hospitals use the extra money they make to pay executives and buy shiny things, rather than making profits that are distributed to shareholders. Cooper says that nonprofit hospitals tend to “invest too much in technology. And the irony is that you get even more expensive things that are probably not necessary – and they suck more money into the health system. “

There are some quirky advantages to being a nonprofit organization for hospitals. You don’t have to pay taxes like for-profit companies do. And while the FTC can block anti-competitive mergers between nonprofit hospitals, current law prevents them from investigating nonprofit hospitals for anti-competitive behavior. “It’s kind of crazy,” says Cooper.

Cooper recently started a project called “1% Steps to Healthcare Reform”. The idea behind this is basically that the American healthcare system is such a daunting mess that we should focus on achievable, incremental steps to improve it. Dealing with hospital consolidation, he says, should be a top priority. And he recently co-wrote a policy brief that describes steps to deal with it.

For starters, Cooper says, America needs to top up its federal antitrust budget. They are inferior and understaffed, and they are struggling to keep up with the tidal wave of mergers and acquisitions that we have seen. Next, he says, we need to authorize federal antitrust authorities to take enforcement action against nonprofit hospitals. And he offers a number of technical legal ideas that he hopes will set the scales of antitrust law more in favor of American consumers.

As for the specific deal between Spectrum and Beaumont, Cooper was reluctant to make a final judgment on the merger without delving into the details. According to the Detroit Free Press, the two health systems have no geographic overlap between them, meaning that they are not direct competitors in the local markets. This can help your case. But, says Cooper, there is some pointers this suggests that even mergers like this, “cross-market mergers”, lead to higher prices for consumers.

We asked Spectrum Health for a comment. “We have a track record of previous integrations, including those with smaller, rural hospitals that focus on helping people stay healthy wherever they live,” they say. “We see the proposed integration with Beaumont Health no differently. We have integrated multiple hospitals and understand the need for quality care in local communities. Patients benefit from a comprehensive health system with many locations and levels of care that are connected as needed and available to meet their needs. “

We’ll have to wait and see if Biden’s arrangement will have any effect on the proposed merger. Cooper is thrilled that the White House is highlighting the problem of hospital monopoly. But so far it’s mostly just words on paper that “encourage” federal authorities to do something about it. We need action from Congress and more work in the FTC to really do something about this problem.

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In Alleged Well being Care ‘Cash Seize,’ Nation’s Largest Hospital Chain Cashes In on Trauma Facilities

After falling from a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years. The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured than those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma Is Big Business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business, by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available round-the-clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma Drama’ in Florida and Beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” council member Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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In alleged well being care ‘cash seize,’ nation’s largest hospital chain cashes in on trauma facilities

After falling from a ladder and cutting his arm, Ed Knight said he found himself at Richmond’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight's wound and sending him home after a few hours, Chippenham Hospital's charges exceeded $50,000, according to a claims document in the case.Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight’s wound and sending him home after a few hours, Chippenham Hospital’s charges exceeded $50,000, according to a claims document in the case. [ JULIA RENDLEMAN | Julia Rendleman for Kaiser Health News ]

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years.

The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals. It operates trauma centers at 11 of its more than 40 Florida hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Related: How HCA turned trauma into a money-maker

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured compared with those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma is big business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available around the clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma drama’ in Florida and beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma-alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter-ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” councilwoman Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Native fifth graders be taught lesson in giving again by elevating cash for Kentucky Youngsters’s Hospital

LEXINGTON, Ky. (LEX 18) – The school year is drawing to a close and has come to an end for some students. At the Lexington Christian Academy, fifth graders celebrated an even more special moment on their last day of school. They presented a check to the University of Kentucky Children’s Hospital. Your donation was the result of teaching and hard work that paid off.

“It was really only the entire 5th grade working together,” says LCA 5th grader Jillian Weaver.

Together they presented a check for US $ 1,650 to Kentucky Children’s Hospital, UK. Dr. Lindsay Ragsdale, a pediatrician at the hospital, accompanied the students, teachers and headmasters to hand over the checks in the school’s gym on Thursday.

LEX 18

“I’m just so grateful. I can’t say enough. Thank you very much,” said Dr. Ragsdale to the class.

The class raised the money by making it themselves.

“I think what this represents is the character and amount of donations this class is willing to make,” says Dr. Ragsdale.

The lessons and hard work began in the classroom. The fifth grade had an entrepreneurship fair where they worked in groups to develop business ideas.

“Well, we came up with Pop-a-Shot. We brought that here,” says Weaver.

“It was a little difficult at first, but when we got it going it was pretty good,” says Kennedy Moughamian, who worked in a group with Weaver.

The ideas ranged from their pop-a-shot business to selling a long-time backpack staple.

“At first we didn’t really know what to do and then I saw some keychains on her backpack and I said, ‘What if we make keychains?'” Says Anna Banks, fifth grader.

Students learned a lot about building a business along the way, how to market their products.

“And to sell that, like many other people, we made posters and put them up at school,” says Rachel Baumgardner, who worked in the key chain business. “I’ve learned that businesses have to make a lot of money and they’re difficult to manage, but it’s also great fun.”

The lessons learned in the classroom stay with these children.

“So we had a test and had to learn the economic definitions,” says Zion Gatewood, fifth grader.

Even more powerful, however, are the lessons learned when they have had the opportunity to give back to their community.

LEX 18

“The fact that they were willing to sell things, make things, and then return things to Kentucky Children’s Hospital – it’s amazing,” says Dr. Ragsdale. “”

“We felt really good,” says Gatewood.