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It’s been said that all’s fair in love, war and politics, but you have to wonder if the public is served when media outlets let their ideological leanings drive their coverage, leaving collateral damage in their wake. No, I’m not talking about Fox News, which, almost always, is guilty as charged. I’m referring to The New York Times, which has an obsession with all things Bain Capital, courtesy of the Mitt Romney connection.
Certainly, as the Obama campaign relentlessly reminds us, Bain is an appropriate story line when the issue of Romney’s economic record and management skills are on the table. But what if a story is really designed to attack Romney by proxy. That seems to be the case with the ‘newspaper of record’, which is aggressively leveraging the ‘anything Bain touches is suspect’ meme by suggesting that the private equity firms passion for profits is responsible for questionable medical care at for-profit hospitals.
The Times hit the Daily Double with two August articles on the alleged misdeeds of HCA, one of the nation’s largest hospital chains, which has the misfortune, according to the Times, of being both partly owned by Bain and a for-profit enterprise.
I have no personal affection for the company and support, with caveats, the president’s health care initiatives. But in reading these two pseudo-investigatory pieces by Julie Creswell and Reed Abelson, one is struck by the realization that they are excellent examples of how journalists can ideologically “frame” and bias a story while appearing to be objective.
The target of the piece—HCA—appears to have been selected almost entirely because it can be linked, ingloriously, to the presumptive Republican nominee for President. HCA has caught the Times’ eye—because Bain Capital—“co-founded by Mitt Romney,” Creswell and Abelson reminds us—bought into HCA in 2006, but years after Romney left Bain, they forget to tell us.
In fact, Bain holds only a fractional investment in this publicly traded, Nashville-based company, along with KKR and others. Bank of America, which acquired a chunk of HCA when it took over Merrill Lynch, cashed out two years ago. Goldman Sachs and JP Morgan had owned pieces of the company in the early 1990s, when it went public for the first time, reaping an eightfold gain. But the Times does not consider those details worth mentioning. That would muddy the narrative. After all, journalists and their editors love “gotcha” pieces. This piece had Bain in its crosshairs and it used HCA as its vehicle of attack.
The second problem is tone. Running throughout is an unstated but clear insinuation that HCA must be doing something wrong because—get this—it’s trying to earn reasonable profits for its shareholders. According to the authors, that’s apparently a mortal sin, a point they reinforce every third paragraph or so.
Now, it is certainly worth exploring whether for profit or non-profit health providers offer the more efficient and quality-focused model. But don’t read these articles if that’s your question. The authors just smugly assume that profits and health care, when joined, are a dirty joint venture.
To make their case, they site such convincing authorities as a former executive at a non-profit hospital, a kidney doctor embroiled in a tempest in a teapot dispute, a CEO of a rival hospital and a slew of “current and former doctors, nurses and administrators,” all of whom remain anonymous. That’s crack reporting.
To bolster its narrative, the Times’ accuses HCA of a laundry list of sins. No company should be above scrutiny, of course, but what’s not clear from this fusillade is whether the authors cherry pick aspects of the HCA record to support a pre-baked story line or whether there is a genuine a pattern of wrongdoing or underperformance.
The authors never quite articulated storyline is that HCA pumps profits by pushing unnecessary and expensive surgery while cutting back on services to the poor that is largely unreimbursed. That’s scathing if true, and because of the Times’ reach and reputation, it’s devastating if not. These are surely not happy times at HCA headquarters. Is this attack deserved?
The first of the two part series, Hospital Chain Inquiry Cited Unnecessary Cardiac Work, attacks HCA for allegedly encouraging procedures, particularly hyper expensive cardiac care, in a bald strategy to increase profits. It includes a stream of anecdotes and “confidential,” unsourced interviews, most from the early and mid 2000s, to make its case. It resorts to dredging up a 13 year old Justice Department investigation of the company that resulted in $1.7 billion in fines.
That scandal is one of the key reasons KKR, Merrill Lynch and Bain moved in to take the firm private—to clean up things up—before rolling it back out to the public again as a far healthier and better managed firm. Instead, the piece makes it seem as if HCA is an ethical nightmare, skating on the edges of illegality, offering marginal health care. The reader has to wade through fully a third of the piece before you get to the key fact that post buyout, 80 percent of HCA hospitals are now ranked in the top 10 percent of government quality rankings. Last spring, HCA was named by the left-leaning think tank Ethisphere as one of the World’s Most Ethical Companies—a fact conveniently missing from this one-sided narrative.
Part II, A Giant Hospital Chain is Blazing a Profit Trail, features a large picture of a St. Persburg, Florida kidney specialist who the Times promotes in bold relief as a “whistle blower.” The focus of this doctor’s complaints: one HCA hospital was accused of poor documentation and not providing drugs ordered by a physician—issues totally unrelated to the Times’ diatribe. His allegations led to fines of $22,000. Quite a dragon slayer.
The embarrassingly thin narrative in this piece is that HCA is guilty of “upcoding,” or billing for more expensive Medicare services than are needed. The key evidence: HCA codes 76 percent of its Medicare payments for emergency room services at the most expensive classifications—as opposed to the national average of 74 percent. But ‘there’s more’, as hawkers on late night TV say.
Ignoring uninsured patients?
“Changing billing codes wasn’t the only avenue HCA pursued in search of higher profits,” the article breathlessly notes. The authors’ strongest venom is directed at HCA’s policy in which uninsured patients who come to an emergency room demanding treatment for routine or non-emergency services are asked to pay a fee to cover the cost of services—which the government won’t fully reimburse.
The story as presented by Creswell and Abelson makes it seem as if HCA abruptly and surreptitiously changed its billing codes three years ago to jack its profits. What they don’t report is telling, and illustrative of the grossly biased style of these “investigative reporters.” The Times never goes so far as to offer support for its allegation that the problem is serious or growing. According to publicly available data, for 2011, HCA affiliated hospitals had more than 6 million ER visitors. About one in 75, or 80,000, were determined not have an emergency condition, and were offered alternative treatment options.
HCA, like many hospitals, has moved in recent years to adopt evaluation and management guidelines developed by that radical, rightwing organization, the American College of Emergency Physicians—a fact the company disclosed publicly. Somehow that didn’t make it into the Times’ story. Other than a few allegations by innuendo offered by an anonymous hospital consulting firm, the Times presents no evidence that HCA’s revised screening policies are in any way underhanded or conflict with superior medical care.
How to handle uninsured patients who frequent emergency rooms is a serious care and cost issue that all hospitals are dealing with, but you’d never know it from the Times’ piece. Creswell and Abelson leave out of their story that the Centers for Disease Control and Prevention has estimated that about 8 percent of ER visits are for non-urgent problems that could be treated less expensively in a doctor’s office or clinic. A 2012 Health Affairs study concluded that the problem was for more extensive and expensive, estimating that more than a quarter of ER visitors would have been more cost-effectively served at doctors’ offices or clinics.
Our health system is currently trapped in a classic lose-lose situation. The un- or under-insured view ERs as their home doctors. They don’t pay for services. Consequently both the hospitals and the government, which covers some ER costs, take a bath.
HCA is hardly alone in trying to address this out-of-control problem, which costs the economy hundreds of billions of dollars a year. Other large for-profit chains, such as Health Management Associates and Community Health Systems, have the same policies. So do many non-profits, such as Halifax Health in Daytona Beach and the massive Kaiser hospital system. But none of these contextual facts graced this one-sided attack.
Curtailing spiraling health care costs is a challenge. The Affordable Health Care Act actually tries to address such prickly issue, but the Times is not advocating problem solving. Rather it eschews context and analysis, indulging in blunt edged hints that HCA, and HCA alone, is “screening out patients too aggressively” to please its private equity masters. What could be an informative story about aspects of our broken health care system instead comes across as an embarrassingly sloppy hit job.
Dark side of the Times
The shoddy reporting reminds me of a famous ditty by the late Sen. Russell B. Long, a Louisiana Democrat, on the tendency of everyone, liberals and conservatives, to always look to ‘the other guy’ to make the necessary sacrifice: “Don’t tax you, don’t tax me, just make the voters think everything’s free.”
Well, health care is not free. Somebody has to pay for the uninsured. Perhaps the president’s health care reforms will help curb soaring health care costs or maybe solutions will be found in aggressive, free market based Republican initiatives. But nothing will happen if the journalists who report on the various options take the easy way out, as the Times appears to be doing in this piece, and throw what amounts to be a temper tantrum. This story reads like a cobbled together piece targeting a well-regarded company that has transparently tried to address one of most recognizable cost and efficiency issues in our health system.
These articles are testament to the lowest standards of reporting: narrative by anecdote bolstered by anonymous sources and leavened by a distinct bias against for profit health care. (Earth to the New York Times: non-profit health organizations are often huge moneymakers; mega non-profit Kaiser Permanente, for example, made almost $2 billion last year.) Maybe HCA deserves this frontal assault on its dastardly ‘for profit’ business model—if so, then go for it, show us ‘the money,’ but do it with contextualized reporting. Instead we are left with two shoddily reported stories, rife with pious insinuations about the evils of making money.
Simply said, myopic journalism makes it impossible for the public to have a reasonable discussion about complex issues. I love my Times, even when I don’t agree with it on some key issues. I can’t wait to read my favorites—Paul Krugman, David Pogue, Gail Collins, David Brooks, David Carr, Andrew Revkin and the best teams of science and international reporters going. What I don’t want—and what the public doesn’t deserve—is innuendo-drenched muckraking. If the Times’ goal, consciously or unconsciously, was to prove that HCA runs underperforming and overcharging hospitals, it’s failed. Instead it’s shined a light on its own reportorial and ethical shortcomings.
Jon Entine is Senior Fellow at the Center for Health & Risk Communication and the Statistical Assessment Service at George Mason University.
It’s been said that all’s fair in love, war and politics, but you have to wonder if the public is served when media outlets let their ideological leanings drive their coverage, leaving collateral damage in their wake.
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