OPINION
the building , another company obtained the license to operate a nursing home , another company provided the professional staff and another the custodial staff .
The owners and managers had spread control over 15 companies and five layers of firms . It was not possible to determine definitely who was responsible for the patient ’ s care . “ Improved efficiency ” in a PE owned nursing home is simply a matter of reducing the most cost of operating the facility , the professional staff , which allows the PE company to extract the annual return on investment with the well documented negative effect on quality of care .
PE owned emergency departments ’ highest operating costs are board certified emergency department physicians . By hiring nurse practitioners and physician assistants ( mid-level practitioners ) and fewer MDs , the profitability increases . 10 The consequence of this from a patient care standpoint is quite different . The cost of care , emergency room length of stay , imaging rates and readmission rates all increase . This results in an increase in out-of-pocket costs to patients .
Surprise billing is another profit increasing tactic of PE owned emergency departments . PE owned emergency rooms , physician practices , ambulance firms and air ambulance companies have all contributed to the outrageous rise of surprise billing . 11 These health care services are taken out of network , so they are not covered by insurance allowing the companies to bill patients directly . Patients taken to an emergency department are in a vulnerable situation seeking care , not thinking about asking if the ambulance company or the emergency room is covered by their policy . This represents one of the most despicable examples of the predatory impact of PE on health care in this country .
A very detailed study published in The Journal of the American Medical Association ( JAMA ) clearly identifies the dangers to care in hospitals acquired by PE companies . 12 Data from 100 % Medicare part A claims for 662,095 hospitalizations in 52 PE acquired hospitals are compared with data from 4,160,720 hospitalizations in 259 matched control hospitals ( not PE acquired ). Medicare patients admitted to PE hospitals experienced a 25.4 % increase in hospital acquired conditions compared to control hospitals . Falls while admitted increased by 27.3 % and central line associated infections increased by 37.7 % at PE hospitals despite placing fewer central lines . Surgical site infections doubled at PE hospitals even though there was an 8 % reduction in surgical volume . It identified a higher pattern of transfer of patients with serious medical conditions ( sepsis ) from PE hospitals to other acute care hospitals . There is a recognition that these patient care issues are related to staffing ratios and compositions , specifically nurses . PE firms improve profitability using a cost cutting strategy that involves reduced staffing and changed clinical labor mix .
The fundamental conflict of interest between seeking profit from health care activities as opposed to providing decent health care to all U . S . citizens is the foundation of the health care industry in
OPINION this country . This expensive , dysfunctional process is becoming exponentially worse with the expansion of the economic predators , private equity , into U . S . health care .
The simple solution would be to expand the basic Medicare insurance to cover all citizens . This would not include the expensive burdensome Medicare advantage , ACO reach and value-based care options that allow the for-profit health insurance companies to raid the Medicare trust fund . The low single digit Medicare administrative cost is a fraction of the administrative cost of the current system . Many of the limitations of the current system ( networks , surprise medical bills , uncovered services ) would simply go away or be reduced ( co-payments , deductibles , high unaffordable premiums ) so much that they would not cause financial ruin to the average U . S . citizen . Providing a non-profit government health insurance option to the American public would not otherwise change the health care system but would reduce complexity and increase access to care .
Sadly , the partisan political divides in our dysfunctional Congress make the prospect of change unlikely anytime soon . Hopefully , at some point in the future , the citizens of this country will tire of being exploited by a health industry and the urban , suburban and rural voters will elect politicians to represent the interests of the people who elected them instead of the interests of the health care profit seekers .
References
1 quayhealth care . com / blog / top-health-insurance-companies-usa
2
New York Times , Sunday Review , November 17 , 2019
3 ncbi . nim . nih . gov > articles > PMC8597930
4
CMS . GOV / INFLATION-REDUCTION-ACT-AND-MEDICARE
5
Courier Journal 24 January 2024
6 medicalnewstoday . com / articles / pharmacy / pharmacy-benefit-manager
7 texastribune . org / 2022 / 06 / 16 / americans-medical-debt
8 wikipedia . org > wiki > Medical _ debt
9 nytimes . com / 2007 / 09 / 23 / business / 23nursing . html
10 npr . org / section / health-shots / 2023 / 02 / 11 / 1154962356 / ers-hiring-fewer-doctors
11
ourfinancialsecurity . org / wp-content / u …/ 2021 / 10 / AFR-surprise-billing- FS-2021
12
JAMA December 26 , 2023 , Volume 330 , Number 24
Dr . Flynn is an Emeritus Professor in the University of Louisville Surgery Department .
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