Many of these complications are designated “never events” because they’re preventable medical errors that should never occur during routine care, such as leaving a foreign object in the body after surgery, failing to correctly match a patient’s blood type, falls, infections at certain kinds of surgical sites or where doctors insert catheters or central lines, blood clots after joint replacement surgeries and pressure sores.

What is the role of private equity ownership in Knoxville hospitals and nursing homes?

Private equity ownership of hospitals made care riskier for patients, a new study finds

yellowdog's picture

Many ER providers are owned by private equity firms

so it is not just "hospitals" that are vulnerable.

jbr's picture

From the article... Private

From the article...

Private equity firms have been acquiring large chunks of the US health care delivery system in recent years. In addition to hospitals, those acquisitions include nursing homes, behavioral health systems, and private physician practices. Academic research has shown that private equity ownership is associated with higher death rates for patients in nursing homes and increased costs to taxpayers.

fischbobber's picture

This covid outbreak

This covid outbreak will be a tremendous stress on our system and give us some fascinating data on several aspects of emergency, infectious disease response, facility utilization and staffing as well as insight as to what wage rate staffing must be brought in at. It's my understanding that a long term nurse standard six month contract is currently $50.00 an hour plus room and board, overtime (1 1/2) and triple time are paid appropriately. I don't think most of our local nurses (particularly young ones) are compensated at that level.

This is our first big post the peak of the pandemic question over the concerns of what the consequences of changing local healthcare policy about, "Well, what's going to happen when?". In this case it's covid, flu, RSV, rhinovirus, strep and some unspecific crud all come in at the same time. It's that time and this is really the first big test of this stage of incorporating and the application of corporate restraint on our infrastructure. This is really the genesis of what for-profit system based on maximizing monetary metrics as opposed to a mission based system based on achieving patient outcome will do. The doctors no longer just don't own themselves, in Knox County, with the Board of Health dissolved, they don't even really have much of a say in what their doing, what patients need and how the resources should be managed in a crisis.

Think about this. The County reported 72 covid patients as a daily average last week. That's roughly 10,000 a day in for billable service for720,000 dollars a day in generated costs. The uninsured will be somewhere north of 10% for their part. That's our part. Last week the taxpayers picked up the table for about 72,000. Not only will those folks be on the taxpayer dime, previous surges run at about a ten percent mortality rate and it's just a question of figuring out this death/diagnoses ratio. They vary slightly from outbreak to outbreak. If this ratio holds true we should see the death toll ride to 5 in the next couple weeks and get to seven (hopefully a new ceiling, preferably less). As to how many total deaths will occur, that will tie itself to the hospitalization rate. I'm hoping those two deaths will attach themselves to a data point that can demonstrate the death rate is declining, but it is way too early to make those calls. I made that mistake in July/August. I'm sticking to history, there's no telling what the immediate future will bring.

Be careful out there. There are vaccinations available for almost everything going around right now. They work. They're safe. Get them.

bizgrrl's picture

This is all a little too

This is all a little too depressing. I have a lot of trust in my healthcare providers. Private equity ownership lowers that trust.

yellowdog's picture

Confidence in for-profit medicine is misplaced

Even if you happen to like your own current circumstances....

jbr's picture

PESP Private Equity Hospital Tracker

Looks like might be of interest...

PESP Private Equity Hospital Tracker

jbr's picture

It would be good to see a

It would be good to see a local news source research what local hospitals, ERs, nursing homes, behavioral health facilities in our area are controlled by private equity sources.

bizgrrl's picture

When you go into a hospital

When you go into a hospital for a procedure (and probably an admission), you sign a document saying you will pay for services not covered by your insurance. It will say that some of the providers are not employees of the facility, thus must be covered separately by the insurance company. However, how can you know if the provider is covered when you don't know who they are or who they work for? Besides being right before you receive the procedure.

fischbobber's picture

Full time daily reporter for local medical infrastructure issues

Compass and KnoxViews both do a pretty good job of covering local medical infrastructure as far as community media services go, but without full time staff, the workload is too overwhelming to be covered thoroughly by citizen journalists. Not bitching, but just noting what's happened since the start of covid, I've had authorship priviledges suspended, been banned outright and have had pieces censored simply for opening a dictionary and figuring out just what was going on. I was kicked off of NextDoor when indoor air quality was found to be a factor in covid spread in our schools. I had a posted censored on Reddit, for redundancy, for pointing out just what exactly was entailed in caring for patients in our emergency rooms on Christmas (Compass left it up). There is no question the County is suppressing data, they haven't published pediatric death statistics since right around the second pediatric death. Pediatric deaths as a result of our schools failure to mitigate the spread of disease will become more and more of a community problem across America. We don't even acknowledge it as a problem.

I went to the mediation hearing over School Masking I sat over with the School System employees mostly shooting the shit about topics from Mildred Doyle to tank tactics since Russ Oaks and I were in ROTC together. I mentioned that I'd just seen research indicating that the airborne viral load within schools had been shown to be linked to faulty ventilation systems and that Washington DC had recently upgraded their HVAC systems to state of the art and had seen improvements, large improvements, over virtually every measurable aspect at every school upgraded, test scores, attendance, both student and faculty was up, significantly. I mentioned to Russ that their program cost 60 million dollars and that it would likely be three times that here, since we had three times as many schools. Schools across the nation were getting this upgrade through ESSER funding. We didn't even apply for it. At any rate, Russ raised his eyebrows and said that it would cost more to do that here, due to the present state of our present systems and what it would take for that kind of upgrade. When I threw out the quarter billion remark he said that was probably ballpark. When Kristi Kristy was interviewed on the Knox Compass Sunday podcast, she acknowledged that many of our systems were so old that they couldn't even find parts for them to keep them operational anymore.

What has happened locally is that those that were warning of the direst of dangers of a failure of covid response is that those folks have been right. Go watch some of the old Board of Health meetings. Look at what other people are doing. Monday, a patient with symptoms of a heart attack had to wait in an emergency room full of unmasked patients waiting to be seen for transmissible respiatory illnesses. Who trains infected peoplke to act in this manner? We're in the midst of a transmissible repiratory disease outbreak and folks that are actively spreading these diseases to the whole hospital aren't even being required to mask in hospitals? Our Health Department is criminally negligent. Glenn Jacobs is currently the head of the Health Department. These are his decisions.

I'm going to end this by posting a link to the Dane County/Madison infectious disease dashboard, where you can find covid data. I'd ask you to note that airborne viral load metrics have their own page. Our only page of covid numbers has four numbers. There a reason we have a thousand excess deaths over their death count. It was the government response to covid that mattered most, from the beginning on.

(link...). (I tried to que this to page five where airborne data is shown. If I didn't get it there, that';s where it is.) This is an example of what a community that is taking covid seriously is doing now.

fischbobber's picture

And really, if you get right down to it.......

This surge isn't even that bad. It's hitting us hard, but it would appear Madison, a county with about 80,000 more people than us topped out at 38 hospitalizations due to covid. We're at 87 and rising. What we see in Knox County today is a covid response issue, something we control, not a covid issue.

We don't have to live this way. We have the option of moving the three politicians, Jacobs, Ward and Zachary that are driving this travesty, as well as any candidates they support, out of office by voting next year.

[Edit on first comment: I was speaking directly to my struggles as a writer in the first comment, mainly because my metrics are up where I can get them. I have no idea what they're doing here. I left off that Kyle Ward tried to have me arrested for noting that the well being of our entire community was at stake with our covid response and that Commission must be stopped by any means necessary. Funny how when you point out the real dangers of a problem he was treating it as lhyperbole, but when I proposed a theorhetical action that was in line with his action he deemed it a threat to his well being. What I obviously meant was that a boatload of people were going to die as a result of his action and that not allowing that action to happen was a good idea. Just to clear everything up.]

R. Neal's picture

Private equity firms seem to

Private equity firms seem to have one purpose: Extract profits by raising prices and cutting costs thru outsourcing, layoffs,"synergy" (consolidating "redundant" operations, i.e. more layoffs), "optimizing" (reducing) quality/services, and raiding any pensions.

Once they drive off all their customers and go upside down, they file chapter 11 to blow off all their investors, creditors, and customers with claims, then start all over.

The mafia calls this "busting the joint out."

bizgrrl's picture

Ex-Senator Bill Frist's

Ex-Senator Bill Frist's family started HCA.

Senator Rick Scott, FL, co-founded Columbia Hospital Corporation that merged with HCA.

In 1993, lawsuits were filed against HCA by former employees who alleged that the company had engaged in questionable Medicare billing practices.[8] In 1997, with a federal investigation by the FBI, the IRS and the Department of Health and Human Services in its early stages, the Columbia/HCA board of directors forced Rick Scott to resign as chairman and CEO amid growing evidence that the company "had kept two sets of books, one to show the government and one with actual expenses listed."[8] Thomas Frist, a co-founder of HCA and brother of U.S. Senator Bill Frist, returned to the company as CEO in 1997...

In July 2005, U.S. Senator Bill Frist sold all of his HCA shares, which were held in a blind trust, two weeks before disappointing earnings sent the stock on a 9-point plunge. At the time, Frist was considering a run for president and said that he had sold his shares to avoid the appearance of a conflict of interest.[54] When the company disclosed that other executives had also sold their shares during that same time, shareholders alleged that the company had made false claims about its profits to drive up the price, which then fell when the company reported disappointing financial results. Eleven of HCA's senior officers were sued for accounting fraud and insider trading.[55] HCA settled the lawsuit in August 2007, agreeing to pay $20 million to the shareholders but admitting no wrongdoing, and no charges were brought.

jbr's picture

Not clear to me but would

Not clear to me but would ...

A strong and unambiguous ban on the corporate practice of medicine exists in Tennessee, supported by a mix of statutes, court decisions, and Attorney General opinions. The Tennessee Practice of Medicine Act and the Tennessee Prohibition Against the Corporate Practice of Medicine Act are two important acts that codify this strict prohibition.

prevent private equity entities from managing emergency rooms?

bizgrrl's picture

Tennessee law restricts the

Tennessee law restricts the ownership of a medical practice and employment of physicians to certain licensed medical providers and facilities, which significantly limits the number of potential buyers for a medical practice. To comply with this restriction while still pursuing investment opportunities, private equity investors developed a transaction structure that allows an outside investor to share in the profitability of a medical practice through a management services organization (MSO).

Any MSO transaction involves the medical practice selling all of its non-clinical assets to an affiliate of the private equity investor while leaving the medical practice entity in place to employ the physicians and bill for their medical services. The MSO then provides to the medical practice the non-clinical assets and services (including billing, lease of equipment, lease of space, and other general management services) in exchange for a management fee. In the MSO transaction, the selling physicians may retain ownership of the practice entity but, pursuant to the terms of the management agreement, they will have little authority over non-clinical aspects of the practice.

It's all getting slicker and slicker.

Treehouse's picture

I believe I was under one of those MSOs

during hip replacement at Ortho Tennessee. I got lots of phone calls and paperwork in advance of the surgery. I was not told what I would be sent home with. The discharge paperwork recommended a responsible adult be with me for 24 hours. Good grief! I needed all the help I had for the first three days. I was still on Oxycodone on day 4, alone and hallucinating. I sent a letter with my complaints and got no response. The doctor didn't get my messages. It took a month to get physical therapy. I'm glad I'm so much better and the doctor and PT were great but the "management" of the practice didn't seem to care.

bizgrrl's picture

So sad and scary.

So sad and scary.

jbr's picture

Senate investigating whether ER care has been harmed by growing

NBC News recently estimated that 40% of U.S. hospital emergency departments were overseen, staffed or managed by companies owned by private-equity firms.

Senate investigating whether ER care has been harmed by growing role of private-equity firms

jbr's picture

Long ER waits plague short-staffed hospitals

While boarding can happen to all ER patients, adults 65 and older, who account for nearly 20% of ER visits, are especially vulnerable during long waits for care. Also, seniors may encounter boarding more often than other patients. The best estimates I could find, published in 2019, before the Covid-19 pandemic, suggest that 10% of patients were boarded in ERs before receiving hospital care. About 30% to 50% of these patients were older adults.

Long ER waits plague short-staffed hospitals, affecting older adults

fischbobber's picture

That pretty much summs up my visit......

I had a staff infection a year or two before covid. I almost lost my arm. I was boarded in a hallway at St. Mary's for about 36 hours, as I re4call. In the hospital ten days. It's my understanding that it's significantly worse now. Maybe the whole point of the way Jacobs runs the Health Department is to make sure people like me DON"T make it. Seems to be the direction our Health Department is heade since Buchanan's departure.

jbr's picture

Private Equity's Latest Target: Your Emergency Room

Private equity is swallowing up America's emergency rooms. 1 in 4 ERs are now staffed by private equity-based firms. The waits are longer, the bills are higher, and ER doctors are being replaced by lower-paid contractors.

Private Equity's Latest Target: Your Emergency Room

jbr's picture

Cancer patients say this hospital turned them away

Memorial is now operated as a for-profit facility by Lifepoint Health, a hospital chain backed by private equity, and it had other plans for her, Quarrell said.

When her doctor called to schedule chemotherapy, the facility asked about her health insurance. She was covered by True Health New Mexico, a marketplace plan under the Affordable Care Act for which she paid $800 a month.

No go, Memorial said...

Cancer patients say this hospital turned them away

Lifepoint Health

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