#hca healthcare

[mostlysignssomeportents]

America's largest hospital chain has an algorithmic death panel

It’s not that conservatives aren’t sometimes right — it’s that even when they’re right, they’re highly selective about it. Take the hoary chestnut that “incentives matter,” trotted out to deny humane benefits to poor people on the grounds that “free money” makes people “workshy.”

There’s a whole body of conservative economic orthodoxy, Public Choice Theory, that concerns itself with the motives of callow, easily corrupted regulators, legislators and civil servants, and how they might be tempted to distort markets.

But the same people who obsess over our fallible public institutions are convinced that private institutions will never yield to temptation, because the fear of competition keeps temptation at bay. It’s this belief that leads the right to embrace monopolies as “efficient”: “A company’s dominance is evidence of its quality. Customers flock to it, and competitors fail to lure them away, therefore monopolies are the public’s best friend.”

But this only makes sense if you don’t understand how monopolies can prevent competitors. Think of Uber, lighting $31b of its investors’ cash on fire, losing 41 cents on every dollar it brought in, in a bid to drive out competitors and make public transit seem like a bad investment.

Or think of Big Tech, locking up whole swathes of your life inside their silos, so that changing mobile OSes means abandoning your iMessage contacts; or changing social media platforms means abandoning your friends, or blocking Google surveillance means losing your email address, or breaking up with Amazon means losing all your ebooks and audiobooks:

https://www.eff.org/deeplinks/2021/08/facebooks-secret-war-switching-costs

Businesspeople understand the risks of competition, which is why they seek to extinguish it. The harder it is for your customers to leave — because of a lack of competitors or because of lock-in — the worse you can treat them without risking their departure. This is the core of enshittification: a company that is neither disciplined by competition nor regulation can abuse its customers and suppliers over long timescales without losing either:

https://pluralistic.net/2023/01/21/potemkin-ai/#hey-guys

It’s not that public institutions can’t betray they public interest. It’s just that public institutions can be made democratically accountable, rather than financially accountable. When a company betrays you, you can only punish it by “voting with your wallet.” In that system, the people with the fattest wallets get the most votes.

When public institutions fail you, you can vote with your ballot. Admittedly, that doesn’t always work, but one of the major predictors of whether it will work is how big and concentrated the private sector is. Regulatory capture isn’t automatic: it’s what you get when companies are bigger than governments.

If you want small governments, in other words, you need small companies. Even if you think the only role for the state is in enforcing contracts, the state needs to be more powerful than the companies issuing those contracts. The bigger the companies are, the bigger the government has to be:

https://doctorow.medium.com/regulatory-capture-59b2013e2526

Companies can suborn the government to help them abuse the public, but whether public institutions can resist them is more a matter of how powerful those companies are than how fallible a public servant is. Our plutocratic, monopolized, unequal society is the worst of both worlds. Because companies are so big, they abuse us with impunity — and they are able to suborn the state to help them do it:

https://www.cambridge.org/core/journals/perspectives-on-politics/article/testing-theories-of-american-politics-elites-interest-groups-and-average-citizens/62327F513959D0A304D4893B382B992B

This is the dimension that’s so often missing from the discussion of why Americans pay more for healthcare to get worse outcomes from health-care workers who labor under worse conditions than their cousins abroad. Yes, the government can abet this, as when it lets privatizers into the Medicare system to loot it and maim its patients:

https://prospect.org/health/2023-08-01-patient-zero-tom-scully/

But the answer to this isn’t more privatization. Remember Sarah Palin’s scare-stories about how government health care would have “death panels” where unaccountable officials decided whether your life was worth saving?

https://pubmed.ncbi.nlm.nih.gov/26195604/

The reason “death panels” resounded so thoroughly — and stuck around through the years — is that we all understand, at some deep level, that health care will always be rationed. When you show up at the Emergency Room, they have to triage you. Even if you’re in unbearable agony, you might have to wait, and wait, and wait, because other people (even people who arrive after you do) have it worse.

In America, health care is mostly rationed based on your ability to pay. Emergency room triage is one of the only truly meritocratic institutions in the American health system, where your treatment is based on urgency, not cash. Of course, you can buy your way out of that too, with concierge doctors. And the ER system itself has been infested with Private Equity parasites:

https://pluralistic.net/2022/11/17/the-doctor-will-fleece-you-now/#pe-in-full-effect

Wealth-based health-care rationing is bad enough, but when it’s combined with the public purse, a bad system becomes a nightmare. Take hospice care: private equity funds have rolled up huge numbers of hospices across the USA and turned them into rigged — and lethal — games:

https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS

Medicare will pay a hospice $203-$1,462 to care for a dying person, amounting to $22.4b/year in public funds transfered to the private sector. Incentives matter: the less a hospice does for their patients, the more profits they reap. And the private hospice system is administered with the lightest of touches: at the $203/day level, a private hospice has no mandatory duties to their patients.

You can set up a California hospice for the price of a $3,000 filing fee (which is mostly optional, since it’s never checked). You will have a facility inspection, but don’t worry, there’s no followup to make sure you remediate any failing elements. And no one at the Centers for Medicare & Medicaid Services tracks complaints.

So PE-owned hospices pressure largely healthy people to go into “hospice care” — from home. Then they do nothing for them, including continuing whatever medical care they were depending on. After the patient generates $32,000 in billings for the PE company, they hit the cap and are “live discharged” and must go through a bureaucratic nightmare to re-establish their Medicare eligibility, because once you go into hospice, Medicare assumes you are dying and halts your care.

PE-owned hospices bribe doctors to refer patients to them. Sometimes, these sham hospices deliberately induce overdoses in their patients in a bid to make it look like they’re actually in the business of caring for the dying. Incentives matter:

https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle

Now, hospice care — and its relative, palliative care — is a crucial part of any humane medical system. In his essential book, Being Mortal, Atul Gawande describes how end-of-life care that centers a dying person’s priorities can make death a dignified and even satisfying process for the patient and their loved ones:

https://atulgawande.com/book/being-mortal/

But that dignity comes from a patient-centered approach, not a profit-centered one. Doctors are required to put their patients’ interests first, and while they sometimes fail at this (everyone is fallible), the professionalization of medicine, through which doctors were held to ethical standards ahead of monetary considerations, proved remarkable durable.

Partly that was because doctors generally worked for themselves — or for other doctors. In most states, it is illegal for medical practices to be owned by non-MDs, and historically, only a small fraction of doctors worked for hospitals, subject to administration by businesspeople rather than medical professionals.

But that was radically altered by the entry of private equity into the medical system, with the attending waves of consolidation that saw local hospitals merged into massive national chains, and private practices scooped up and turned into profit-maximizers, not health-maximizers:

https://prospect.org/health/2023-08-02-qa-corporate-medicine-destroys-doctors/

Today, doctors are being proletarianized, joining the ranks of nurses, physicians’ assistants and other health workers. In 2012, 60% of practices were doctor-owned and only 5.6% of docs worked for hospitals. Today, that’s up by 1,000%, with 52.1% of docs working for hospitals, mostly giant corporate chains:

https://prospect.org/health/2023-08-04-when-mds-go-union/

The paperclip-maximizing, grandparent-devouring transhuman colony organism that calls itself a Private Equity fund is endlessly inventive in finding ways to increase its profits by harming the rest of us. It’s not just hospices — it’s also palliative care.

Writing for NBC News, Gretchen Morgenson describes how HCA Healthcare — the nation’s largest hospital chain — outsourced its death panels to IBM Watson, whose algorithmic determinations override MDs’ judgment to send patients to palliative care, withdrawing their care and leaving them to die:

https://www.nbcnews.com/health/health-care/doctors-say-hca-hospitals-push-patients-hospice-care-rcna81599

Incentives matter. When HCA hospitals send patients to die somewhere else to die, it jukes their stats, reducing the average length of stay for patients, a key metric used by HCA that has the twin benefits of making the hospital seem like a place where people get well quickly, while freeing up beds for more profitable patients.

Goodhart’s Law holds that “When a measure becomes a target, it ceases to be a good measure.” Give an MBA within HCA a metric (“get patients out of bed quicker”) and they will find a way to hit that metric (“send patients off to die somewhere else, even if their doctors think they could recover”):

https://en.wikipedia.org/wiki/Goodhart%27s_law

Incentives matter! Any corporate measure immediately becomes a target. Tell Warners to decrease costs, and they will turn around and declare the writers’ strike to be a $100m “cost savings,” despite the fact that this “savings” comes from ceasing production on the shows that will bring in all of next year’s revenue:

https://deadline.com/2023/08/warner-bros-discovery-david-zaslav-gunnar-wiedenfels-strikes-1235453950/

Incentivize a company to eat its seed-corn and it will chow down.

Only one of HCA’s doctors was willing to go on record about its death panels: Ghasan Tabel of Riverside Community Hospital (motto: “Above all else, we are committed to the care and improvement of human life”). Tabel sued Riverside after the hospital retaliated against him when he refused to follow the algorithm’s orders to send his patients for palliative care.

Tabel is the only doc on record willing to discuss this, but 26 other doctors talked to Morgenson on background about the practice, asking for anonymity out of fear of retaliation from the nation’s largest hospital chain, a “Wall Street darling” with $5.6b in earnings in 2022.

HCA already has a reputation as a slaughterhouse that puts profits before patients, with “severe understaffing”:

https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122

and rotting, undermaintained facililties:

https://www.nbcnews.com/health/health-care/roaches-operating-room-hca-hospital-florida-rcna69563

But while cutting staff and leaving hospitals to crumble are inarguable malpractice, the palliative care scam is harder to pin down. By using “AI” to decide when patients are beyond help, HCA can employ empiricism-washing, declaring the matter to be the factual — and unquestionable — conclusion of a mathematical process, not mere profit-seeking:

https://pluralistic.net/2023/07/26/dictators-dilemma/ggarbage-in-garbage-out-garbage-back-in

But this empirical facewash evaporates when confronted with whistleblower accounts of hospital administrators who have no medical credentials berating doctors for a “missed hospice opportunity” when a physician opts to keep a patient under their care despite the algorithm’s determination.

This is the true “AI Safety” risk. It’s not that a chatbot will become sentient and take over the world — it’s that the original artificial lifeform, the limited liability company, will use “AI” to accelerate its murderous shell-game until we can’t spot the trick:

https://pluralistic.net/2023/06/10/in-the-dumps-2/

The risk is real. A 2020 study in the Journal of Healthcare Management concluded that the cash incentives for shipping patients to palliatve care “may induce deceiving changes in mortality reporting in several high-volume hospital diagnoses”:

https://journals.lww.com/jhmonline/Fulltext/2020/04000/The_Association_of_Increasing_Hospice_Use_With.7.aspx

Incentives matter. In a private market, it’s always more profitable to deny care than to provide it, and any metric we bolt onto that system to prevent cheating will immediately become a target. For-profit healthcare is an oxymoron, a prelude to death panels that will kill you for a nickel.

Morgenson is an incisive commentator on for-profit looting. Her recent book These Are the Plunderers: How Private Equity Runs — and Wrecks — America (co-written with Joshua Rosner) is a must-read:

https://pluralistic.net/2023/06/02/plunderers/#farben

I’m kickstarting the audiobook for “The Internet Con: How To Seize the Means of Computation,” a Big Tech disassembly manual to disenshittify the web and bring back the old, good internet. It’s a DRM-free book, which means Audible won’t carry it, so this crowdfunder is essential. Back now to get the audio, Verso hardcover and ebook:

http://seizethemeansofcomputation.org

If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/08/05/any-metric-becomes-a-target/#hca

[Image ID: An industrial meat-grinder. A sick man, propped up with pillows, is being carried up its conveyor towards its hopper. Ground meat comes out of the other end. It bears the logo of HCA healthcare. A pool of blood spreads out below it.]

Image: Seydelmann (modified) https://commons.wikimedia.org/wiki/File:GW300_1.jpg

CC BY 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en

#pluralistic #hca healthcare #Gretchen Morgenson incentives matter #death panels #medicare for all #ibm watson #the algorithm #algorithmic harms #palliative care #hospice #hospice care #business #incentives matter #any metric becomes a target #goodhart's law

[amitkrsaroj]

Best Stroke recovery center HCAH

Experience the best stroke recovery center health care at Home HCAH. Their expert team offers comprehensive care and rehabilitation services to aid in the recovery process. Trust HCAH for personalized support on the path to healing.

#pets #hca healthcare #hcah #exoert #seo expert #seeo #seo

[reportwire]

Chutes & Ladders—Google snipes FDA's digital lead; Cerebral CEO out amid fed investigation

Chutes & Ladders—Google snipes FDA’s digital lead; Cerebral CEO out amid fed investigation

Chutes & Ladders—Google snipes FDA’s digital lead; Cerebral CEO out amid fed investigation dmuoio Thu, 05/19/2022 – 18:17 Source link

View On WordPress

#Cerebral #Chutes and Ladders #Digital health #Dignity Health #fda #Fierce Healthcare Homepage #google #HCA Healthcare #Health tech #Hospitals #lifespan #Providers #retail #Rush Health Systems #RWJBarnabas Health #Telehealth #UPMC #Walgreens

[discoveringkristine]

Real Talk from a Healthcare Assistant: Feeling Drained but Staying Strong 💙

Hey friends, just gotta be honest here. Working in healthcare can be exhausting. Lately, I've been feeling drained and worn out.

Big shoutout to all the other healthcare workers out there. You're all incredible! And to our patients, thank you for letting us care for you.

Let's remember to take care of ourselves too, okay? We're a team, and we've got each other's backs! 💙 #HealthcareHeroes #SelfCare

#healthcare #hca #dementia #nz #ofw #im so tired #mentally tired #emotionally drained

[ramenheim]

My three-tiered olive zippered skirt came in...... 🤩

#with all three tiers zipped on I need my platforms to keep it from dragging 🥰 #I had such an issue getting it pushed through to canada #first time wearing it #very euphoric tbh love looking like an anonymous gender blob #much needed after that shift I had; hope that HCA gets fired for that shit jfc #who the fuck yells at a pt that she's ''gonna come in there & beat the shit outta [pt]´´ #die immediately actually Do Not pass go do NOT collect a paycheque #the way the fucking healthcare system borderline rewards making indigenous pts unsafe in the ER is wretched #reported her directly to FM & didn't see her for the rest of the shift; good fucking riddance #not the first time she's pulled similar hostile shit in a crisis intervention either she needs to be Fucking Investigated+Suspended w/o pay

[usnewsper-politics]

HCA Uses AI To Generate New Medical Treatments #ai #generativeai #HCA #healthcare #healthcareorganizations

#Health #ai #generativeai #HCA #healthcare #healthcareorganizations

[pokecatt]

#medicare #kfc #Hca #for profit healthcare #Shouldn't be a thing #Now I want kfb #Youtube

[locationscloud]

LocationsCloud provides a complete list of HCA Healthcare locations in the USA with geocoded addresses, phone numbers, open hours, stock tickers, etc. You can download the best quality and latest updated HCA Healthcare locations data at an affordable price.

Email:  [email protected]

Phone: [phone]

#HCA Healthcare Locations Data #HCA Healthcare Locations #Locationscloud

[physicianready]

When it comes to healthcare jobs, they are highly rewarding. In the past few years, the job opportunities for healthcare professionals are increasing at a fast pace.

#Hospital in Pasadena TX Houston #Hca Houston Healthcare Medical Center

[autisticadvocacy]

Doctors and nurses at HCA Healthcare, the largest hospital chain in the U.S., have raised concerns about hospital policies that push patients to begin end-of-life care when there may be other options available. A report by NBC News found that this practice lowers HCA’s rate of in-hospital deaths and makes beds available for more profitable patients. HCA’s CEO compensation is tied to in-hospital deaths, setting a dangerous incentive to reduce that number at the cost of quality patient care.

Our health care system devalues the lives of people with disabilities and chronic health conditions. HCA Healthcare’s use of internal policies and algorithms to deter patients from continuing life-lengthening care means this hospital system is acting in the interest of profits, not patients. Entering hospice must always be a personal choice. A hospital that pressures patients to stop life-saving treatment if they are perceived as likely to die will cause premature deaths among people with disabilities who seek treatment.

ASAN is deeply against any policies, formal or informal, that devalue the lives of people with disabilities and make us more likely to die, whether that be medical rationing due to COVID-19 cases, physician-assisted suicide, restrictions on organ transplantation for people with disabilities, or policies that push patients into hospice prematurely. We will continue to fight to prevent the deadly consequences of these policies.

The Autistic Self Advocacy Network seeks to advance the principles of the disability rights movement with regard to autism. ASAN believes that the goal of autism advocacy should be a world in which autistic people enjoy equal access, rights, and opportunities. We work to empower autistic people across the world to take control of our own lives and the future of our common community, and seek to organize the autistic community to ensure our voices are heard in the national conversation about us. Nothing About Us, Without Us!

Read the full statement: https://autisticadvocacy.org/2023/08/asan-condemns-hospital-policies-that-value-profits-over-patients/

[angel-of-the-moons]

Nursing home called....

Said my dad had a stroke.

EMS neglected to mention that when they dropped him off at the hospital (they did this once before, thankfully it wasn't a stroke that time)

The doctor tried to fight my mom and snapped on her when she wanted him transferred to the better hospital.

They are lucky I wasn't there,bi would have punched her. I slept on the floor for 8 hours in that fucking hospital the last time he was admitted for a possible stroke--all because EMS didn't tell the staff he had stroke-like symptoms.

Do NOT use HCA hospitals, particularly the one in LC Florida. They will kill you before they help you. Century EMS will do the same.

I hate this fucking country's healthcare system, I fucking hate that nothing is getting better for us, I fucking hate that my family can't catch a fucking break.

And my friend's funeral is this fucking weekend.

I'm going to wind up in the mental ward.

#🌙 arch's thoughts #im pissed

[azspot]

Of course, America was generating a new economy, but it was far different from what Silicon Valley and its White House cheerleaders had imagined. Wal-Mart and McDonald’s, Amazon and FedEx, Marriott and HCA Healthcare, all were giant growth companies. Software engineers and computer support specialists were among the fastest-growing occupations, but when it came to sheer numbers, occupational growth was still concentrated in low-wage, low-skill jobs in retail trade, food preparation and restaurants, hospitals, nursing homes and home health care, janitorial services, and offices. These jobs were often structured and supervised by a new digital infrastructure—call center and warehouse work were prime examples—but they were hardly of the sort envisioned by “new economy” enthusiasts. Indeed, that phrase faded in the new millennium, replaced by descriptors of a far darker character: “the gig economy,” “surveillance capitalism,” and “the fissured workplace.” Of course, none of this lessened the impact of high-technology companies on American politics and discourse. Silicon Valley’s determination to “change the world” had been backstopped by a tenfold increase in the amount of money Democrats raised from that sector between the 1994 and 2000 election cycles.

Bill Clinton Campaigned as a Progressive. Why Didn’t He Govern Like One?

#clinton

[earthstellar]

on Propranolol (beta blocker) again for both cardiac and anxiety reasons

honestly it fucks with my asthma meds (some of which are beta agonists, so essentially they cancel each other out a little)

but I enjoy the "I'm not sedated but it sure feels that way" vibe that I personally get from this med lmao

if there's a Cybertronian equivalent of Propranolol, I have to wonder if Ratchet himself might potentially benefit from it, given his spark issues...

although it might be more effective for something like managing certain types of spark destabilisation, not chronic/long term spark burn out, but it could maybe be part of a condition management plan for some age related spark conditions which Ratchet's burn out at least partially qualifies as (on top of likely being stress exacerbated etc.)

once again wishing we had more canonical Cybertronian health details but I am Like This so of course I want those deets, lmao

in the universe where the Lost Light just kept on adventuring, I'm sure First Aid would eventually suggest it to Ratchet once they caught on to what's happening, earlier intervention may have been helpful and I think First Aid even suggests this to be the case in the last issue (would need to double check and I'm on work break right now lol)

but I can fairly easily imagine that Drift would eventually get worried enough about Ratchet's health that between him and First Aid, Ratchet would probably submit to the necessary exams/tests and at least give it a go lol

first few days would be amazing

"Ratchet do you have the data pad with today's outpatient clinic list on it?"

"eh"

"okay. Velocity, do you have the data pad with today's outpatient clinic list on it?"

lmao

he would adjust to it fairly quickly but that initial adjustment period would have Drift hovering around in the med bay like an HCA (healthcare assistant), just to keep an eye on him

Ratchet would try to complain about it but he'd be too physically zoned out for it. "I'm relaxed but not because I want to be. Aid, put those fragging tools back. Pretend I am shouting." First Aid would just give Drift a reassuring thumbs up while Ratchet's leaned back in his desk chair and can't see it lmao

Ratchet ends up falling asleep at his desk the first day and wakes up covered in a tarp/blanket Velocity had draped over him at some point (with Drift hovering nearby, of course)

Drift still worries but First Aid explained that the medication can contribute to drowsiness etc. so even though Drift is concerned, he thinks it's probably good that Ratchet's operating at a slower (and healthier) speed, and he's happy Ratchet is finally getting some much-needed care and rest :')

Still stresses Drift out to see Ratchet so slow and seemingly sedated for the time being, but he trusts First Aid and knows it's worth trying

Ratchet is mad about it lol but also admits that his spark compartment and chest mechanisms are less sore and he doesn't feel as overclocked as usual-- He does feel old, though, and doesn't like being slower and more tired even though that should improve a bit gradually, but he knows it's good to have finally sought out care, even if he only did it for Drift's sake (at first, anyway)

I gotta go back to work now so this isn't really a complete thought or anything but in my defense Propranolol has me slow as hell today LMAO

#idw ratchet #idw drift #idw first aid #lost light #mtmte #maccadam #maccadams