Clinicians claim HCA hospitals push patients into end-of-life care to boost metrics

Higher-ups within HCA Healthcare place pressure on staff in hospitals to persuade patients' families to initiate end-of-life care, which can limit treatments for patients but curb in-hospital mortality rates and length of stay for the hospital operator, according to claims made in a June 21 NBC News report. 

The NBC News article is based on interviews with six nurses and 27 physicians who currently or previously practice at 16 HCA hospitals in seven states. Nashville, Tenn.-based HCA operates 184 hospitals in 21 states and the United Kingdom. 

Each clinician said the HCA hospitals pushed palliative and hospice care in pursuit of better quality or operational measures, such as in-hospital mortality rates, readmissions and length of stay.

HCA's in-hospital mortality rate is one of 10 "quality of care" metrics used since 2021 to calculate the incentive pay received by top company executives, according to financial filings reviewed by NBC News.

HCA spokesperson Ed Fishbough denied the claims in the following statement with Becker's

"While NBC News admits there is no tangible support for their claims, the suggestion that medical care in HCA Healthcare hospitals is based on anything other than a physician’s independent medical judgement is not true, and it is irresponsible. 

"Due to patient privacy, we were not able to address medical care provided to any individual patient without their permission. Despite several requests, NBC News refused to help us secure permission. We urged NBC News to review the medical records of any patient they intended to use in their story," Mr. Fishbough said. "It is important to know, and we shared this with NBC News, that when a physician recommends hospice care, that recommendation is included in the medical record, whether the patient/family agrees to hospice care or not. It would be misleading and dishonest to ignore the medical record when reporting on care provided to any patient." 

NBC News said internal hospital documents and texts between hospital employees provided to the news network support the healthcare professionals' views.

One document recommends palliative care be considered for "patients with prolonged length of stay." Staff described an algorithm — called the vulnerability index — used at two HCA hospitals to identify patients who are most likely to die soon. Patients who rank high on the index become candidates for palliative care.

An internal analysis from one HCA hospital about three years ago shows that almost one-third of its palliative care consultations resulted in admission to inpatient hospice or a hospice discharge plan, according to the NBC News report.  

The HCA spokesman declined to comment to NBC News about the algorithm. 

The NBC News report is related to and coincides with an 18-page report issued June 21 by union SEIU — titled "Masking Mortality" — which analyzes hospice care practices at HCA hospitals. SEIU members are calling on regulators to investigate HCA's practices around patient discharges to hospice and other serious allegations.

"The SEIU propaganda document, upon which the NBC News stories are based, is not a serious report," Mr. Fishbough said in a comment on behalf of HCA Healthcare to Becker's. "It is filled with misleading and absurd accusations based on a lawsuit that was voluntarily dismissed after the government decided not to intervene. Length of stay and mortality rates are two common metrics used by CMS and others in healthcare to measure hospital quality. We believe aligning our leaders’ compensation with quality is not only the right thing to do but also supports our focus on continuous quality improvement.

"Unfortunately, it appears NBC News decided to be a willing participant in SEIU’s smear campaign against our organization."


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