I-Team: Hospital chain stands out when billing Florida trauma patients

Critics say HCA's trauma charges are excessive

HUDSON - The name on caller ID was her son's. So Terri Jwanouskos answered the phone with: "Oh, hi, Mason."

It wasn't her son. It was a paramedic.

Riding in a car that ran off the road in Pasco County, the teenager, now 17, suffered a concussion when the vehicle plowed into an iron gate.

Paramedics rushed Mason to Regional Medical Center Bayonet Point's trauma center. His injuries turned out not to be a threat to his life.

"I was relieved for the fact that he did not have broken bones or open injuries or was unconscious," said Bruce Jwanouskos, Mason's father.

But that didn't stop the hospital from charging his family one of the highest trauma response fees in the state. "Just to walk in the trauma center, they charged us $33,000," Terri Jwanouskos said. "That's just to go in the door."

As the ABC Action News I-Team recently reported, the trauma fee has been around for more than a decade. It is used to cover the cost of special equipment, advanced training and medical specialists who are on call for emergencies.

But the I-Team, in partnership with the Tampa Bay Times, has discovered these fees are rising rapidly and are used more often than they should.

The Times spent the past year reviewing more than 10 million patient records and one fact became abundantly clear: A string of new trauma centers opened by Hospital Corp. of America, or HCA, is charging the highest trauma admission fees ever seen in Florida.

The 20 trauma centers in the state owned by HCA competitors have an average trauma response fee of about $6,000. Those that are owned by HCA charge more than $27,000 on average --- four-and-a-half times as much.

The six highest trauma response fees in Florida are all charged by hospitals owned by HCA, which also operates Bayonet Point, where Mason Jwanouskos was taken.

"I can't even begin to tell you what justifies that cost," Bruce Jwanouskos said of his son's hospital bill.

Fred Moore, chief trauma surgeon at the University of Florida's Shands Hospital in Gainesville, says the drive for profits is behind HCA's massive expansion of trauma centers. All six of HCA's Florida trauma centers have opened in the last five years.

"If you're a for-profit company, you're there to make a profit," said Moore.

Moore says the HCA centers are driving up trauma costs. "It's just the opposite of what we're supposed to be doing," the surgeon said.

HCA executives declined an opportunity to discuss their trauma fees in an on-camera interview with the I-Team.

In a written statement to the I-Team, however, the hospital company noted: "HCA trauma centers are providing excellent high quality care, outperforming all other trauma centers in the state of Florida with lower mortality rates, lower complication rates, and shorter length of stay.

"Equating charges, including trauma activation charges, to the amounts patients pay for medical care is misleading."

The company added in a statement to the Times that the areas served by all six of its trauma centers experienced a decrease in mortality rates while only half of the other areas served by competing trauma centers showed a decrease in mortality rates.

"While we don’t know how others set their fees, we use a methodology that bases the amount of response fees on the actual costs required to make sure all of the necessary life-saving services of a trauma center are ready when they are needed," the HCA statement reads.

For that higher quality of care that HCA executives claim to provide, the Times research shows the company charges a hefty premium. The average per-day trauma care cost at HCA hospitals now tops $20,500. Non-HCA hospitals come in 43 percent lower, at an average daily cost of less than $12,000 a day.

HCA is Florida’s most powerful hospital network. The company operates 42 hospitals in the state, twice as many as its closest competitor.

In the late 1990s, it was famously headed by Gov. Rick Scott when federal agents accused the company, then called Columbia-HCA, of profiteering from unnecessary tests and false diagnoses. Scott resigned amid the scandal while admitting no wrongdoing. The company later pleaded guilty to 14 corporate felonies and agreed to pay the largest Medicare fraud fine in the nation's history.

Now restructured, the Nashville-based company and its publicly traded stock have thrived on Wall Street in recent years, thanks to strong profits.

HCA executives declined to detail how much the company is making from trauma patients. But the Times has learned that HCA negotiated contracts with leading insurers to award the company an unusually generous percentage of everything charged to trauma patients. This special payment plan is triggered every time a patient is charged a response fee.

Confidential documents obtained by the Times show that Florida Blue, the state’s largest private insurer, pays HCA hospitals a percentage of what they charge to trauma patients — meaning the more the company charges, the more it gets paid. The documents show Florida Blue paid HCA an average of $117,150

for each trauma patient. That’s nearly double the $60,147 per trauma case that Florida Blue paid other state trauma centers.

“They are making money on this,” Florida Blue Vice President Andy Marino told the Times.

Last year, Florida Blue reduced the percentage it pays. Citing non-disclosure requirements, the insurer would not say how much.

But Humana, another major insurer, is paying HCA as much as five times more than it pays other hospitals for trauma cases, said Joe Piemonte, Humana’s regional director of hospital contracting.

“When somebody’s loved one is in an auto accident, sure, the prospect of having a trauma center right down the street versus 30 minutes away sounds like a good thing,” Piemonte said.

Until the price for relatively minor injuries is considered.

"You have to re-evaluate whether it is a good thing to add all of these maybe not necessary services at exorbitant costs,” Piemonte added.

Huge bills for less-than-life-threatening situations come as no surprise to the Jwanouskos family.

It look less than 30 minutes for Mason Jwanouskos to rack up $50,000 in diagnostic-imaging charges at Bayonet Point.

"It was a shock," said his mother. "It was a shock to see."

By the time Mason was released from Bayonet Point the day after the vehicle crash, the bill had grown to $99,000.

Following the accident, the boy's licensed-contractor father, Bruce Jwanouskos, began taking on extra jobs.

Bayonet Point eventually agreed to settle the family's bill for $35,000 --- a third of the original amount. Still, a billing expert who examined Mason's itemized hospital charges called it one of the worst cases of overcharging she had ever seen.

Nora Johnson, a medical reimbursement auditor, told the Times that the entire hospital stay should have been priced around $5,000 --- less than what Bayonet Point charged for a single scan.

"I could have probably gotten all three of my kids a two-year degree for the amount of money that they've taken," said Bruce Jwanouskos. "When you put it in comparison to that, it's downright scary."

Do you feel you, a loved one or a friend have been overbilled for trauma care at a local hospital? Tell us about your experience at iteam@abcactionnews.com.

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