Strange Tony,
The public submitted over 1,600 comments on private equity's impact on healthcare. The comment period was extended from May 6th to June 5th. So the door remains open for those wishing to share their thoughts and experiences with financial rapscallion ownership. A number have struck me to date.
Anonymous said:
Private equity's focus on short term profits before all is antithetical to providing quality, humane, sustainable healthcare. The industry's track record of extracting every bit of cash from companies they acquire at the expense of customers and employees before selling off a ruined husk unable to continue existing is horrifying, at best. Continuing to expose something as critical to the well-being of our citizens and whole society as healthcare to such predatory and self-destructive practices would be an absolute travesty and a self-inflicted cancer on the very fabric of our country.
Another commenter provided the following:
Many of thepworst instances of a poorlygfunctioning corporate governance/economic incentive system have been through U.S. private equityafirms mismanaging investments in U.S. healthcare and technology companies -- are just the uniquely awful examples with broad public awareness. Private equity firmslcynically deny they have operational control of their portfolio companies when abuse is revealed, despite their effectiveicontrol through an interlocking directorate of board members, investors, and economic incentives. Some limited partner investors arevincentivized into complicity through access, equity co-investments, or fee breaks. Employees and management teams at these portfolio companies, like helots, are retaliated against if they speak out of line.
The current governancepsystem in place for private equity is not effective and the DOJ, FTC, and Department of Health and Human Serviceseshould have a greater degree of oversight to stop this from happening again. This induced trauma is happening with full awareness from the wider private equity ecosystem. Many of the most resourced private equity firms in the world are right nowucolluding to ringfence their own liability and cover up the impact this misappropriation of resources is having on our healthcare system.
A physician from hell-hound (Cerberus) trained Steward Health offered:
My 2 partners and I sold our independent medical practice of 9 primary care providers to Steward health in 2019, then quit them in 2022. A long list of failed contract fulfillments includes: wouldn't pay vendors (credit holds precluding ordering flu shots, equipment), maintenance, cleaning (we often cleaned and fixed our own offices, did necessary yard work after hours, etc), and tried numerous times to extort us out of money owed contractually. Showed up to office with contract addendums asking us to sign with hidden language to relinquish bonuses or change pay formula. We started having serious management calls within 6 months, lawyer meetings within 1.5 years. We were collectively underpaid 100k each year because they failed to calculate this correctly, necessitating a battle to correct, even thought the factual data was easy to interpret.
They hid financial metric data from us to facilitate their underpayments to us for which we were forced to go directly to insurers or individuals within Steward (off the books) to locate. Our group was never payed a large percent of Medicare earnings and multiple years and ACO shared savings (though SHCN) of which was another story in/of itself. Was told a legal judgement against Physician Group of Louisiana would be easy, but collecting would be impossible because of the many tiered LLCs and ZERO assets in any of the ones that contractually own the practices/employ physicians. We were watching our community hospital in West Monroe, LA, being sucked dry all while they were acquiring more hospitals in TX, AZ, FL, and individually pocketing an exorbitant "acquisition fee" when they sold the assets WAY above FMV to Medical Properties Trust (which is about as legitimate as Pablo Escobar's taxi business) then letting the operating side IMMEDIATELY suffer.
Guys, Steward was not set up to operationally succeed, they were set up (likely by multiple closed door PE backer meetings - like ones with Cerberus) to provide immediate dividend/distributions on invested capital by selling WAY above any legitimate FMV (so...seemingly everything else in healthcare is regulated by not exceeding FMV, but this isn't???), signing ridiculous leaseback rates (precluding any entity from being able to purchase asset in future when the operating side INEVITABLY declines (because it was an afterthought, and not set up to succeed)), and distributing a stupidly high dividend to private investors.
I personally am not against for-profit or even PE in healthcare, and absolutely see the premise of hawking a profit margin. But seeing this run from the inside (shutting down hospital profit centers, disallowing local decisions, stiffing community businesses accounts payable, routinely extorting from physicians.. the list goes on) it's very evident this is solely a real estate asset scheme. All Steward owned hospitals more than 1 year behind on accounts payable should be seized by the state government and resold to community after having 2 or 3 external FMV evaluations. You guys decide if MPT is illegal or not, but no question it's unethical. It will sink it anyway when you seize all the hospital assets back. But you should absolutely take back EVERY dollar of real estate acquisition fees that PE/Steward owners took out of the hospital property within 3mo of purchase.
They have raped our communities. And other companies are building business models similar to this. If I can be of assistance please reach out. I have kept a good bit of files, contract infractions related to our time at Steward (lots of lawyer meetings, were prepping to sue them, remember).
A nurse practitioner wrote:
I am a psychiatric nurse practitioner. I am not often privy to the administrative changes nor the financial machinations of the organization I work for. What I do know is that since being taken over four years ago by a private equity firm – an agency that works primarily with a Medicare and Medicaid population who has a high percentage of SMI patients (those with significant and serious mental illness) – the quality and availability of our services has significantly declined. We can not seem to recruit nor retain any counseling staff, let alone those with the skills needed to work with this population nor the required licensing that some insurances require in order to treat their patients. We are down to very few counseling hours and it is uncommon to hire staff, and even more uncommon to have them stay.
What is distressing is to sit with patients day after day and know that I can only prescribe medication, and give them at most 20 minutes of my time, and then send them on their way. I sat with three patients last week who all disclosed a history of incest, two of them discussing it only recently. So many of my patients have significant and debilitating Post-traumatic Stress Disorder from their traumatic life histories, and I have little to offer but medication and a little empathy. What they need is quality, ongoing, targeted therapy, but they can not access it. They can’t get it here because we have been starved of funds and therefore staff. As far as I can tell, they can’t access it anywhere in my county as there are few if any therapists accepting patients, let alone those on Medicare or Medicaid.
When I have a child or a teen who is struggling and has a potential for violence, we are being told that our local crisis won’t transport them to the ER. I am supposed to “fix” them with medication because not only do we not have therapists, but we have few if any services in the schools and almost none in the community. We talk and talk about increasing mental health services for kids due to a myriad of reasons – school shootings, increases of suicides, increases of drug use – but in the past four years, services have been in a steep decline.
Additionally, my father died a terrible death from ALS last year. He died alone because no one at the abysmal facility he was at which was two hours away from us had the heart to tell us he took a turn for the worse. He was on a ventilator as he deteriorated quickly. Due to a lack of adequate reimbursement, no facility anywhere close to us had a bed open for him. We tried to get hospice but it was too late, the facility stymied anything we tried to do. He died alone and suffering and that was after we did all we could to protect him. Our system is broken beyond repair, and I wish that anyone who is trying to profit off of patients could have seen my poor suffering father, and the grief of my mother, who tried everything she could to give him comfort and peace during a cruel and horrific illness.
For-profit heath care is an evil that must stop. People are making money off of the backs of people with schizophrenia, victims of incest, people with autism, and any number of other mental health concerns. Making money off of the back of my suffering father – why is this allowed to happen? I’m sick and tired and frustrated and I plan to leave health care as soon as I can.
Three of the four comments came from people on the inside. The financial rapscallion cancer runs deep in our healthcare non-system. It's a widespread harm, reaching from autism to nursing home care to hospitals to oncology. It needs to be excised.
Anonymous
No comments:
Post a Comment