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California Watch: Prime Healthcare reports outsized rates of unusual conditions

Prime Healthcare reports outsized rates of unusual conditions
from California Watch, October 15, 2011

Prime Healthcare Services, a chain of 13 hospitals in Southern California and one in Shasta County, reports higher rates of several serious medical conditions than other California hospitals. At the same time, former doctors and employees of Prime say that chain owner Dr. Prem Reddy has urged doctors and medical coders to log those conditions, which pay a premium when treating elderly Medicare patients. Here’s a primer on how we [CA Watch] calculated hospitals’ diagnosis rates.

Hypertension or Malignant Hypertension?


The National Institutes of Health estimates that about 1 percent of hypertension cases are the very serious form, malignant hypertension. California hospitals not owned by Prime reported it in 2.6 percent of hypertension cases in 2010. Prime hospitals reported it at much higher rates – as high as 38 percent at one facility, Desert Valley Hospital. Hospitals can earn about $3,000 more per case when reporting the more serious condition.

 

Fainting or Autonomic Nerve Disorder?


Autonomic nerve disorder is a rare condition that most California hospitals do not report seeing. Yet several Prime hospitals reported dozens of cases. Treating the disorder – a potentially deadly condition related to Parkinson’s disease, diabetes and alcoholism – can earn $5,000 more for a hospital if coded the right way.

Confusion or Encephalopathy?


Hospitals in California reported the brain disease encephalopathy in 3.6 percent of elderly Medicare patients in 2010. Prime Healthcare reported a higher rate – 18 percent chainwide and 36 percent at one of its nonprofit hospitals, Encino Hospital Medical Center. A hospital could earn $7,000 per case for treating the condition as a complication of pneumonia.


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