HCA Healthcare's lack of transparency, low staffing draws concern from workers | Opinion
Nurses, healthcare workers, and patient advocates rallied recently in front of the Nashville headquarters of HCA Healthcare, the nation's largest hospital chain, to coincide with the company's annual shareholders meeting.
Specifically, we're demanding that HCA improve worker safety and patient care quality and access by increasing frontline hospital staffing levels and posting all actual prices in compliance with federal law. These changes are necessary to protect workers’ and patients’ health and financial security.
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Patients and workers come first
A recent SEIU study reveals how HCA systemically short-staffs its 182 hospitals across the country. By analyzing Medicare cost reports, the study concludes that HCA's nurse and support worker levels are 30% below the national hospital average. The report demonstrates a pattern of staffing levels declining significantly after HCA takes over a hospital.
Inadequate nursing staffing levels threaten patient safety. In a 2022 survey of over 1,500 HCA nurses and healthcare workers, nearly 80% reported witnessing patient care being jeopardized due to low staffing. It is no surprise that government reports show that HCA hospitals have higher readmission rates than the national average.
A patient at an HCA hospital in Houston in 2019 was allegedly neglected and forced to sit in her own urine and feces. A lawsuit filed by her family alleges requests for help were ignored due to staff shortages, resulting in a bladder infection and painful sores.
Short-staffing poses risks to the safety and livelihoods of caregivers. Nurses at HCA report fearing that their nursing licenses will be in jeopardy because of tasks left incomplete when they are too short-staffed to meet all of their patients’ needs.
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A lack of transparency
HCA is also failing to properly disclose its actual prices, in defiance of a hospital price transparency rule that took effect on January 1, 2021. A recent PatientRightsAdvocate.org report reveals that none of the 173 HCA hospitals examined are in compliance with the transparency rule. Many have failed to completely and clearly post their actual prices, including their discounted cash and insurance plan rates, as required.
This lack of transparency prevents HCA consumers from lowering their costs by comparison shopping. The impact on consumers can be profound. For example, a recent study in Nature finds that the cash price for prostate surgery varies nationwide by 32 times, from $1,476 to $47,445, depending on where it is performed.
Transparency about actual, upfront prices empower patients to choose care at fair market rates. It prevents hospital price gouging and provides recourse for patients who are overcharged. Price transparency protects patients from hospitals’ revenue maximization schemes and from joining the 100 million Americans with medical debt.
By cutting hospital staff to save on labor costs and failing to disclose prices (often leading to outrageous after-the-fact bills), HCA has generated enormous profits for its executives and shareholders. In 2022, HCA made $60.2 billion in revenue and $5.6 billion in profit. It paid its CEO, Sam Hazen, $14.6 million in compensation. Since 2011, HCA has paid out $32.2 billion to investors in buybacks and dividends. Its stock price has nearly doubled since the pandemic.
HCA's public comments suggest short-staffing and hidden prices are a deliberate corporate strategy to profiteer on patient misery. HCA's CEO has said, "Our productivity is at a very efficient level when it comes to employees per patient." In its 2022 annual report, HCA admits, "Trends toward clinical and pricing transparency may impact our competitive position, ability to obtain or maintain favorable contract terms and patient volumes in ways that may be difficult to predict."
Nurses and patients refuse to accept this status quo that disproportionately hurts the most vulnerable Americans and exacerbates healthcare inequities. By improving nursing staffing levels and clearly posting its prices, HCA can fulfill its stated commitment “above all … to the care and improvement of human life” – a promise that should always trump another billion dollars of profits for shareholders and executives.
Cynthia A. Fisher is the founder and chairman of PatientRightsAdvocate.org. Leslie Frane is the Executive Vice President of the SEIU.
This article originally appeared on Nashville Tennessean: How HCA's profits over workers approach hinder's patient experience
