Several friends sent me a link to an article that I had already seen. It’s upsetting but not surprising. the title of the article is “Serious Medical Errors Rose After Private Equity Firms Bought Hospitals”. You can find the article here.
The title of the article pretty much tells you all that you need to know. A study published in JAMA showed that there was an increased rate of inpatient complications such as falls and infections in hospitals that were purchased by private equity investment firms. They did not find that there was an increase in mortality, though it is inevitable that an increase in complication rates will, over time, almost certainly increase mortality rates for patients. You can access the JAMA article here.
I have discussed the near death event that my father experienced in a hospital stay after a fairly routine surgical procedure to repair a kneecap fracture. That horrific set of events did NOT take place in a private equity health care system. So I am not suggesting that one type of system is free from harmful events. Yet, after the completion of my father’s surgery, he went to an inpatient acute rehabilitation facility within the existing hospital. It is a rather odd situation in which there is a rehabilitation facility nestled within the larger hospital. Although it physically within the main hospital, it is considered a different facility. Thus, my father stayed within the physical building of his surgery, but was “discharged” and then “admitted” into the rehabilitation floor of the same hospital. Weird, right? There reason for this is a complicated discussion about payments.
Here’s the thing….at this point, if you are discharged from a hospital, insurance companies such as Medicare (and many others), no longer want to pay hospitals for readmissions. These insurance companies are basically saying that they should not pay hospitals for the complications that the hospitals themselves are causing. For example, if you get a wound infection after surgery and have to be readmitted for antibiotics, many insurers are refusing to pay the hospital for this. They feel that the hospital did not take the proper measures needed to prevent the infection and they should no longer have to pay the hospital for the readmission and treatment of that infection. This makes sense to me, because prior to these changes, hospitals had no incentive to try and improve the safety of care. If they caused a complication, they got paid to fix the complication. It may not surprise you then, that hospitals were not doing all that much to improve the safety and quality of the care they were providing. Some financial pressures on hospitals can force them to improve their processes. But, healthcare systems are complex, and there can be unintended consequences of these well intended policies.
It has been hard not to feel that as my father got sicker and sicker in rehab from the UTI he acquired in the hospital, that they were reluctant to admit him back into the main hospital because they would not get paid for the readmission. I don’t necessarily believe that they had a formal discussion about not readmitting him because of money, but people are aware of financial expectations and pressures. They know.
After my father’s cardiac arrest and prolonged ICU stay, he was still recovering in the regular medicine ward when he again had a low grade fever and his urine looked dark and nasty. The response to this was rapid and complete. He had labs, was started on antibiotics, and was closely followed in a matter of a few hours. That was NOT what happened in the rehab facility when he was found to have a urinary tract infection. As he got sicker, consultation was slow, testing was slow, antibiotic arrival was slow. My father continued to worsen and no one seemed to look at the big picture of his condition. This would have been unlikely if he had been readmitted to the hospital.
I tell my father’s story again, because if every decision becomes more and more a financial decision, this will play out on the quality of the care patients receive. Complications will invariably increase. While mortality rates didn’t increase (and the authors of the JAMA article had some theories on this) during this study, it is hard to imagine that over time, those increased complication rates will lead to increases in mortality.
Given a choice, I would not bring those I love to a hospital that is run by a private equity firm.