As an economist who has studied monopolies and market power extensively, HCA’s attempted takeover of Steward Healthcare should be a major cause of concern for everyone in our state — patients, insurers, employers and frontline health care workers.
Research has shown that reducing the number of health care providers in each market does not lead to an increase in care quality. In fact, patients usually see an increase in prices for the care they rely on as competition is eliminated. Skyrocketing prices for lifesaving hospital care harms patients and communities, exacerbating existing economic inequities and health care injustice.
Salt Lake City patients are already paying the price for hospital consolidation as the cost of standard procedures has ballooned in recent years. Taking a colonoscopy as an example of a standard procedure, the hospitals with the most expensive negotiated rates charged patients nearly four times more than the least expensive ones. The average price of the procedure rose to more than $1,000 for privately insured patients in 2008-2011, and it’s probably even higher now. In other words, HCA’s proposed merger would only worsen a trend that has been hurting the people of Utah for a long time.
HCA’s hospitals in Utah charge between four and almost seven times the cost of providing care, consistently above and in some instances nearly double the statewide averages of prices for the same services. These high charges spell increased costs for the public with no benefits in return, except for HCA’s shareholders and corporate executives in Nashville, Tennessee.
Increased costs to patients are not the only threat if this deal goes through. The consolidation this purchase would bring would likely harm patient care standards and reduce wages for health care workers. A recent study of a similar for-profit hospital acquisition found that promises of improved care and economics did not materialize for the regions affected.
The concern with this acquisition is not merely that HCA’s market power will grow, but that HCA would trigger a race to the bottom by putting pressure on its Utah rivals to cut costs instead of prices to compete, thereby worsening the quality of care we receive. All of this would be done while HCA simultaneously passes more of its costs along to consumers, insurers, employers, health care workers, and taxpayers.
This merger does not bode well for the people of Utah. Every one of us, at one time or another, will visit a hospital. If this transaction is permitted to go forward, Utahns will pay the price and HCA’s shareholders will profit.
One by one, the nurses taking care of actress Judi Evans at Riverside Community Hospital kept calling out sick.
Patients were coughing as staffers wheeled the maskless soap opera star around the California hospital while treating her for injuries from a horseback fall in May 2020, Evans said. No one had told her to wear a mask, she said. “It didn’t cross my mind, as I’m in a hospital where you’re supposed to be safe.”
At the time, concerns about covid were mounting among the staff at Riverside Community Hospital, a for-profit HCA Healthcare facility.
The hospital’s highly protective N95 masks had been pulled off the supply room shelves and put in a central office, according to Monique Hernandez, a shop steward for her union, Service Employees International Union Local 121RN. Only nurses who had patients getting aerosol-generating procedures such as intubation — which were believed at the time to spread the virus — could get one, she said.
She said that practice left the nurses on her unit with a difficult choice: either say you had a patient undergoing such procedures or risk getting sick.
On April 22, 2020, Hernandez and other nurses joined a silent protest outside the hospital where they held up signs saying “PPE Over Profit.” By that time, the hospital had several staff clusters of infection, according to Hernandez, and she was tired of caregivers being at risk.
In a statement, Riverside spokesperson David Maxfield said the hospital’s top priority has been to protect staff “so they can best care for our patients.”
“Any suggestion otherwise ignores the extensive work, planning and training we have done to ensure the delivery of high-quality care during this pandemic,” he said.
There, many of her nurses wore masks they had previously used, Evans recalled. Other staffers came in without any masks at all, she said. A few days in, she said, one of the doctors told her it’s crazy that the hospital was testing her for MRSA and other hospital infections but not covid.
After about a week in the hospital, Evans said, she spiked a fever and begged for a covid test. It was positive. There is no way to know for certain where or how she got infected but she believes it was at Riverside. Covid infections can take two to 14 days from exposure to show symptoms like a fever, with the average being four to five days. According to CDC guidance, infection onset that occurs two days or more after admission could be “hospital-associated.”
Doctors told her they might have to amputate her legs when they began to swell uncontrollably, she said. “It was like being in a horror film — one of those where everything that could go wrong does go wrong,” Evans said.
She left with over $1 million in bills from a month-long stay — and her legs, thankfully. She said she still suffers from long-covid symptoms and is haunted by the screams of fellow patients in the covid ward.
By the end of that year, Riverside Community Hospital would report that 58 of its 1,649 covid patients were diagnosed with the virus after admission, according to state data that covers all payers from April to December.
That’s nearly three times as high as the California average for covid cases not present on admission, according to the analysis for KHN by California health data officials.
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As HCA tripled their profits in the last quarter and the Omicron variant surges, frontline HCA workers inside their hospitals receive poverty wages as low as $26,000 per year. Click here to take action!