Prime Healthcare Services - Response To Recent Controversy

Response To Recent Controversy

Prime maintains that their billing practices are legal and proper and claim that the high rate of kwashiorkor is a result of proper diagnosis of malnutrition. They also claim that they are the victim of a campaign by Service Employees International Union (SEIU), but the California Medi-Cal fraud director claims that his bureau had initiated an investigation before SEIU released their findings.

Prime Healthcare hospitals assert that they do not use a diagnosis of malnutrition to increase reimbursement. Indeed, the relevant (i.e., where the diagnosis affected reimbursement) malnutrition rate at all Prime Healthcare hospitals was 3.6%, which is much less than the rates referenced in the article. For example, the relevant malnutrition rate at Huntington Beach Hospital was 5.3% rather than the 39% reported by California Watch.

In addition, the higher than average malnutrition rates at Prime Healthcare hospitals are the result of Prime Healthcare's commitment to providing high quality healthcare for all of its patients for which Prime Healthcare insists they should be applauded rather than criticized. Published studies estimate that up to 15% of ambulatory elderly patients, up to 44% of homebound elderly patients, up to 65% of hospitalized elderly patients, and up to 85% of nursing home patients are malnourished. Given these statistics and the morbidity and mortality rates associated with undetected and untreated malnutrition, Prime Healthcare hospitals have implemented a nutritional screening program in order to improve patient care outcomes and decrease mortality and morbidity. This program includes policies and procedures designed to ensure that each elderly patient admitted to the hospital receives a nutritional screening.

Physicians also routinely order serum albumin tests and promptly assess patients based on the serum albumin levels and other malnutrition indicators. While this initiative has undoubtedly improved patient care outcomes and decreased mortality and morbidity, it has also resulted in more Medicare patients being properly diagnosed with malnutrition and the average malnutrition rates being higher at Prime Healthcare hospitals than other hospitals. However, the increase in malnutrition diagnoses has not lead to a similar increase in reimbursement as a substantial majority of the malnutrition diagnoses did not lead to enhanced reimbursement. Rather, these quality measures and Prime Healthcare's commitment to providing the highest quality of patient care lead to Prime Healthcare being ranked as one of the Top 10 Health Systems in the Nation by Thomson Reuters, the only for profit hospital system to be so recognized.