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After falling from a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN. HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA Healthcare’s “activation” fees for trauma care in Georgia are double those at other hospitals in the state, according to a Kaiser Health News report this week.

The company’s Georgia fees of about $15,000 are actually lower than those in most other states where HCA operates trauma hospitals, the KHN analysis found. Those activation fees elsewhere run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists.

HCA runs Memorial Health in Savannah, as well as hospitals in Dublin, Waycross, Vidalia and Augusta.

Nashville, Tenn.-based HCA Healthcare's average activation fees at its trauma centers can be up to 10 times higher than those at non-HCA hospitals, according to Kaiser Health News.

Trauma centers have become part of HCA Healthcare's growth strategy, corporate officials have said, according to a June 14 KHN report. The hospital operator has trauma centers in more than half of its 179 hospitals.

Publicly posted price lists show HCA Healthcare's trauma activation fees can be up to $50,000 per patient. In California, for example, the average trauma activation fee for HCA is $38,804, compared to an average non-HCA charge of $18,253, according to 2020 data cited by KHN.

Hospitals are increasingly selling troves of de-identified medical data. Rochester, Minn.-based Mayo Clinic is using its patient data to create an artificial intelligence factory with Google. Nashville, Tenn.-based HCA Healthcare and Google inked a multiyear collaboration to build a health data analytics platform to support its operational workflows…

...Even as patients and physicians navigate difficulties obtaining medical record details in a timely fashion, hoards of unregulated patient data are passing through hospital networks and into the hands of tech companies, the article noted.

....In one example, a data aggregation firm may use the data to target patients for pharmaceutical detailing and encourage physicians to push their products, which can increase drug costs and the overprescription of medicine.

Patients are at risk for being reidentified. Since the U.S. doesn't have a comprehensive data privacy law, there are no regulations to protect patients from the harm that could come from being reidentified. There are also no regulations requiring hospitals to notify the patients if they have been reidentified, the authors said.

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