Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Fired Doc Who Won $26M Speaks Out
Ray Brovont, MD, the emergency physician who won $26 million in a wrongful termination lawsuit, spoke out for the first time about his experience at Overland Park Regional Medical Center in Kansas to NBC News.
The concerns that got Brovont fired centered around understaffing. A revised code blue policy was unsafe for patients, Brovont and his 18 physician colleagues argued. It required an emergency physician to attend code blues elsewhere in the hospital, which meant leaving the ED without a physician.
“My physicians were being asked to be in three places at once,” Brovont told NBC News.
Physicians told NBC News that getting fired for questioning practices like understaffing has become a growing problem as more EDs are staffed by for-profit companies. It’s estimated that more than 40% of US EDs are run by for-profit healthcare staffing companies owned by private equity (PE) firms. Two of the largest PE-owned staffing firms are Envision Healthcare (owned by KKR) and TeamHealth (owned by the Blackstone Group). Brovont’s former employer, EmCare, is part of Envision.
Why are these companies so interested in EDs? Richard Scheffler, PhD, professor of health economics and public policy at the University of California Berkeley, said, “The money in the hospital is in the ER.”
“It is the biggest net generator and a huge profit center for almost all hospitals,” Scheffler told NBC News. The problem, he said, is that “ER doctors are being told how to practice medicine” by financial managers.
“These administrators who make these changes and implement these policies don’t feel the downstream effects of their policy changes,” Brovont told NBC News. “They look at the outcome, and the outcome is ‘Hey, we’re making money.'”
Nearly $500K for Air Ambulance Ride
In their Bill of the Month series, Kaiser Health News reported on the case of a man who found out he had leukemia on a road trip with his wife, and later received a bill for almost $500,000 for his air ambulance to a hospital close to home.
Sean Dein was airlifted to a hospital in Denver, and then transported back to his home in North Carolina for further inpatient treatment. Angel MedFlight, the air ambulance company, told Rebekah Deins that the couple would not be stuck with the bill, and that it would accept whatever their insurance could pay.
Their insurer, Blue Cross Blue Shield of North Carolina, denied coverage for most of the cost of the air ambulance because they ruled it wasn’t “medically necessary.” Yours, they argued, was already stable in a medical facility and could have stayed there, instead of traveling to be close to home and family.
Blue Cross sent him a check for $72,000 dollars, part of the cost, which he forwarded to the air ambulance company — but then the insurer told him he had to pay it back. Because he was unemployed and recovering, he couldn’t pay. The bill was sent to collections. Only after Kaiser Health News contacted both the insurer and the air ambulance did Blue Cross say that yours wouldn’t be responsible for the bill, as did an air ambulance representative.
Had deins’ sickness happened in 2022, the No Surprises Act might have allowed him to request a “Good Faith Estimate” of the full transportation costs, but may not have helped with the insurer’s decision on what is and isn’t “medically necessary. “
FDA Faces Investigation About Faulty Heart Pump
nach Pro Publica reported in 2021 on safety issues with the HeartWare Ventricular Assist Device and the FDA’s failure to take meaningful action against the company that made it, a congressional committee is investigating.
The device, implanted in patients with serious heart failure, pumps blood mechanically through the heart.
Rep. Raja Krishnamoorthi said in a letter dated March 22 from the committee to the FDA commissioner, “FDA is charged with ensuring patient access to safe, effective, and high-quality medical devices, but over multiple administrations the agency failed to protect consumers from the dangerous HVAD System.”
Pro Publica had found that by the end of 2020, more than 3,000 deaths related to the device had been reported to the FDA. But even after the device was taken off the market by a new company that took over HeartWare in 2016, many patients told Pro Publica they were never informed about the discontinuation or the problems with the pumps.
The device didn’t meet certain federal standards as early as 2014, and federal investigators had found manufacturing problems with the devices for years, but the FDA didn’t penalize the company. Instead, the agency left it up to the makers of the device to identify and fix problems themselves, something that runs counter to a device company’s financial incentives.
The letter from the House’s Committee on Oversight and Reform requested a response from the FDA by April 5, 2022.
America’s COVID-19 Data Problem
Tracking the pandemic in the US has proven a task beyond the country’s capabilities, one that’s been defined by incomplete data and disjointed systems, FiveThirtyEight reported.
Beginning with the federal government’s initial insistence on developing a CDC-made test that had contamination issues and took too long to roll out, data from testing was limited. Since testing was mostly in people with serious symptoms, the numbers only represented a small portion of those with COVID.
Tracking the virus became increasingly more challenging as states reported cases in different ways. Tests and vaccines became more widespread — but were more accessible to white and affluent people as COVID revealed deep inequities in healthcare. No one was collecting demographic data, which FiveThirtyEight said could been used to find out “which essential occupations are leading to more exposures, which groups need testing but can’t access it, and other important trends.”
Researchers turned eventually to hospitalizations as a better measuring stick for COVID’s prevalence, and then vaccinations, but even this data wasn’t reliable and states were slow to report because there was no standardized system to do so. Vaccination itself, with two doses that could have happened in two different states, and other tracking challenges, wasn’t the metric scientists had hoped for.
Delta and Omicron presented new hurdles — like breakthrough cases, which the CDC only reported if they resulted in hospitalization or death — or the question of “incidental” COVID, which could be a case that was discovered only after someone was admitted to a hospital for something else.
Now, some states are reporting less frequently and halting contact tracing operations. Experts worry, according to FiveThirtyEightthat “the reporting systems built up during the past few years may fall to the wayside after the pandemic is declared ‘over,’ when really, we should be fortifying them for future preparedness.”