The Palm Beach Post deserves kudos for exposing how Florida governor Rick Scott conducted the business of his urgent care clinics in the state, and what his actions reveal for health care to come. Scott is something of health care’s bad boy, having gotten into trouble running Columbia/ HCA, the giant for-profit hospital chain owned by the Frist family of Tennessee. That’s Frist as in former Sen. Majority Leader Bill Frist. In the late 1990s, the FBI uncovered a Medicare billing fraud scheme involving Columbia hospitals. Columbia later settled the case and paid a fine. Two execs went to jail, and Scott got millions in walking away money.
Post health and science reporter Stacey Singer discovered that the same practices Scott pushed at Columbia—bottom-line, bonus-focused management that encouraged a culture of cheating—were deployed at his Solantic Urgent Care clinics, which have just been sold to a New York private equity firm. Using the old-fashioned reporting technique of plowing through government documents, Singer revealed the aggressive, profit-first strategy that guided the management of the clinics. Kind of makes you wonder how patients fared, doesn’t it? Doctors and nurses were expected to stand through fourteen-hour shifts. “They actually told us not to sit down for 14-hour shifts,” family doctor Randy Prokes told state investigators. “(Scott) does not care about the quality of medicine. They care about how fast you see people.” I can’t imagine a doc who has been on his feet all day wants to spend much time with anyone, especially those who come last. Soltanic eventually fired Prokes.
Clinic managers came and went in rapid succession, and Prokes said many wrote him up for a number of infractions—arriving five minutes late, failing to suggest Solantic’s pharmacy at three points of contact, and suggesting patients might want to return another time when the wait was shorter. Cameras in the clinic waiting areas monitored doctors who were expected to suggest extras like vitamins and probiotics. After Obama’s inauguration, Scott started an organization called Conservatives for Patients’ Rights and bought TV ads to preach against the dangers of socialized medicine and the public option. The objective of health reform, we were told, was to make things better for patients and foster patient-centered care—the things Scott’s clinic seemed not to do.
Other documents Singer examined showed one clinic in Broward County was projected to see 6,500 patients in 2012. Later Solantic’s accountants said such projections were conservative. Another accountant boosted the projection to 10,600 patients, an increase of 37 percent in a single year without an increase in staff. Singer interviewed an attorney/accountant named Jerre Frazier, retained by Columbia/HCA in the mid 1990s to evaluate the company’s legal exposure as the Medicare scandal grew. He told Singer Solantic’s practices sounded similar to those at Columbia.
There would be Monday night meetings when proposals would be made to Rick Scott, and if the proposal didn’t meet the bottom line, Rick Scott would say, ‘Just increase the numbers of patients the doctors will see to make the numbers work. If the doctors can’t make the numbers, then fire them.’
“There’s a calculus in health care where it pays to cheat,” Frazier told Singer. “There’s a 98 percent chance you won’t get caught. They just laugh and say, ‘Well, we like those odds.’”
Singer and her paper need to keep an eye on Solantic under its new owners who are running the chain for profit, of course. And while they’re at it, they should keep tabs on Florida regulators. If health care is going more corporate, then someone needs to look out for the patients. That’s a perfect role for health reporters and their papers.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.