CBS' “60 Minutes” said it talked to more than 100 current and former employees of Health Management Associates for Sunday night's segment focusing on claims that HMA pressured physicians to meet admissions quotas regardless of medical necessity.
HMA, a Florida-based company, owns three for-profit hospitals in Central Pennsylvania: Carlisle Regional Medical Center, Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center.
Of the three, only CRMC was mentioned last night, with two physicians who formerly worked there featured prominently on the broadcast. Dr. Cliff Cloonan was CRMC's assistant emergency room director, and Dr. Scott Rankin worked in the same department.
"My department chief said, 'We will admit 20 percent of our patients or somebody's going to get fired,'" Cloonan said on the broadcast, noting that unjustifiable admissions put patients "at significant risk for hospital-acquired infections."
Rankin added that, for patients 65 and older, the admissions benchmark was 50 percent.
This morning, CRMC CEO John Kristel and two staff physicians, Dr. Howard Alster and Dr. Scott Miekely, denied that administrators pressured admissions decisions.
"Our physicians make medical decisions based on what's most appropriate for our patients," Kristel said. "Myself and other hospital administrators do not get involved in clinical decision making."
Kristel noted that both Cloonan and Rankin left CRMC of their own accord.
Alter has been at CRMC for 26 years, and the medical staff has elected him to his third term as medical staff president. He called the statements on the show "a misrepresentation of how we operate" and "not in line with my experience," saying that excess admissions would have been picked up by a medical staff peer review if they had occurred.
"In my years as an ER doc, I've never been told by an administrator elsewhere or here that I had to meet a quota," said Miekely, CRMC emergency department medical director.
Both other HMA hospitals in the area had no statement beyond what HMA has issued, which follows:
"According to their report, '60 Minutes' conducted more than a year of research and found no issues with the quality of care at Health Management hospitals, stating on the broadcast that 'hardly anyone we talked to complained about the quality of care at HMA hospitals.'
"It was also notable that '60 Minutes' failed to identify a single patient who had been inappropriately admitted from any of the company's emergency rooms, including by the physicians interviewed.
"Neither '60 Minutes' nor the physicians interviewed identified any admission decision in which a physician's medical judgment was overridden by an HMA executive, much less to defraud Medicare.
"'60 Minutes' did not in any way dispute the admissions data it was provided by Health Management over the last several months. That data demonstrated that admissions rates from the company's emergency rooms were in-line with national norms and consistent over a several-year period.
"Instead, '60 Minutes' relied entirely on disgruntled former employees of the company and former contracted physicians, several of whom are seeking financial gain through active litigation with Health Management."
Update, 4:30 p.m.: The Pennsylvania Medical Society has said it is not in a position to comment on the validity of the "60 Minutes" report. However, it has released an editorial by its president, Dr. C. Richard Schott.
"As the state physician association, we can say that the best medical decisions are made when physicians, leading a team of health care providers, work closely with their patients without the presence of financial pressures," Schott wrote. "PAMED estimates that approximately 70 percent of physicians are now employed by a large group, hospital, or health system. Physician employees must put the needs of patients far ahead of their or their employers’ economic needs.
"As our country works its way through health care reform, we have the opportunity to build a better health care system. The foundation for this system is patient care delivered by the physician-led health care team," Schott wrote.