NAPLES — Several physicians who formerly worked in hospitals run by Naples-based Health Management Associates contend a software system in the emergency room boosted tests and admissions to make money for the company.
The physicians, none of whom worked at HMA's three hospitals in Southwest Florida, aired their grievances about the ProMed software on a recent "60 Minutes" report about the for-profit hospital chain.
But HMA says the software was used to help doctors track a patient's care, while the president of ProMed Clinical Systems, based in Coral Springs, said the software was simply an aid to doctors — not a system for determining whether to admit a patient.
The early December "60 Minutes" report raised questions about the software even though HMA had discontinued using it in January 2011.
HMA's move away from ProMed came months before HMA was subpoenaed in May and July 2011, company officials said. The federal government is investigating the medical necessity of emergency room admission and test practices at HMA, according to company filings with the U.S. Security and Exchange Commission.
"The ProMed software does not decide whether to admit a patient or not," said Alan Levine, a senior vice president with HMA.
Instead, the software organized patient information in the computer system. Today, other industry-accepted software, called InterQual, uses clinical criteria to help determine if the patient should be admitted, Levine said.
All three hospital systems in Southwest Florida — HMA, Lee Memorial Health Systems and NCH Healthcare Systems — use InterQual.
The NCH Healthcare System, which has two hospitals in Collier County, released data that showed its Medicare admissions averaged 44.6 percent.
"Based on the InterQual criteria, a patient meets criteria but it does not mean that person has to be admitted," Levine said. "There's always a reason why a doctor might deviate from it. All the physician has to do is document it. Every hospital uses some type of system that helps patient flow."
Thomas Grossjung, ProMed's president and chief executive officer, said the software documents the patient's information and test results, and prompts for data before a patient's record is closed.
"It asks, 'Do you want to consider this?'" Grossjung said. "It's an aid, it's a help tool. It doesn't make decisions. It doesn't admit patients. It doesn't code or bill."
The software can be customized to incorporate which diagnostic tests should be done based on symptoms and protocols that the medical staff has decided to use to be more efficient, Grossjung said.
But a lawsuit filed in 2006 under the federal False Claims Act by several doctors at HMA's Yakima Regional Medical & Cardiac Center in Washington mirrors complaints made by the doctors in the "60 Minutes" segment that aired Dec. 2.
Initially filed as a court-sealed whistleblower complaint in U.S. District Court in Eastern Washington, the lawsuit was voluntarily dismissed and unsealed in March 2009, records show. ProMed wasn't named as a defendant.
By the numbers
The for-profit HMA is the fourth-largest hospital chain in the nation with 70 hospitals, including the two Physicians Regional Medical Centers in Collier County and one in Lehigh Acres in Lee County.
In the complaint, Drs. Joel Heinzen and Christopher Rhead said ProMed was programmed to automatically order tests after nurses entered triage information on patients — and that some of the tests weren't necessary. Heinzen declined comment; Rhead couldn't be reached for comment for this story despite repeated attempts.
The complaint said ProMed also tracked physician productivity, which focused on how often a physician would override the software's recommendation that patients be admitted.
Levine, who joined HMA in 2010, said at the time of the 2006 lawsuit the use of software to streamline the ordering of basic tests based on a patient's complaints was in its early stages. He said the move to use information technology in medicine hasn't been an easy transition for some physicians.
"It was a new way of doing things," he said. "They were upset at us for looking at productivity. Even today, doctors don't like the use of (information technology) systems. There will always be people out there who don't like to be measured."
Today, the use of "standing orders" or test maps, based on patients' symptoms and complaints, are incorporated in emergency room software; it is an accepted practice and recommended by the American College of Emergency Physicians.
The standing orders are developed and approved by the medical staff at the hospitals, Levine said.
The professional association of emergency physicians helped convince the U.S. Centers for Medicare & Medicaid in 2009 that this was good practice for efficiency and for getting care to patients faster, according to the Emergency Physicians group's website.