“Most of our patients coming for elective work come in through here,” Dr. Hasan Hashmi says as he stands in a hospital waiting room that is completely empty. No patients seeking elective work are in sight nor are any staffers behind the receptionists’ desk to admit them. “The admission staff right now, since there's nobody here, they’re probably out to lunch.”
Roger Rhodes, the CEO of Hashmi’s hospital, walks behind the vacant desk and disappears to retrieve one of the missing staffers. “Most of the time, you see somebody here,” Hashmi continues. “Most of the time, you’d see a patient getting registered.”
A few moments later, Rhodes finally emerges back from behind the admissions’ desk, but he has failed to produce a receptionist. “They are, in fact, having a short training class right now,” he says. “So our receptionist would call back and alert them if someone arrived.”
Welcome to Texas General Hospital, a new, sleek-looking facility next to the train tracks in Grand Prairie. In the four years since it opened, Texas General Hospital’s founder Hashmi has pitched his business as a much-needed service, as the only hospital in Grand Prairie.
But independent research has given this hospital a different sort of publicity: It's the hospital that charges the most money over the actual cost of services in the state of Texas.
Johns Hopkins researchers, using Medicare data, last year ranked the 50 hospitals in the country with the highest mark-ups over actual costs. Texas General hospital came in at number 11, making it the worst in the state.
The report found that the typical U.S. hospital charged an average 3.4 times the Medicare-allowable cost in 2012. The 50 hospitals in the report charged an average of more than 10 times the Medicare-allowed costs. “The combination of a lack of regulation of hospital charges in the United States and no market competition is leading to price-gouging that trickles down to nearly all consumers,” the report says.
Since these high markups are often used by hospitals as leverage to negotiate higher prices with private insurance companies, anyone with commercial insurance is affected. “We as consumers are paying for this when hospitals charge 10 times what they should,” Hopkins researcher Gerard Anderson said shortly after his study came out. “What other industry can you think of that marks up the price of their product by 1,000 percent and remains in business?”
The Observer contacted the hospital regarding a patient who underwent foot surgery here in 2014 who received a bill this summer asking for over $330,000. In response, Hashmi invited the Observer to the hospital for a tour, joined by his chief nursing officer Charlyn Pafford Wagley and CEO Roger Rhodes.
“We hear about gouging patients, it really breaks our heart, to tell you honestly,” Hashmi says. “Because when you look at it, when you will leave from here, and you look at what happens here, what happens generally with our patients, you will see this is an absolute genuine operation, trying to take care of poor people.”
The Observer encountered around two dozen hospital employees throughout an hourlong our tour of the facility, but no patients.
The hospital gladly accepts Medicare and Medicaid — as signs across the facility remind — but the hospital officials deny that most of their profits come from the government’s pockets. Hashmi claims the hospital’s money comes from the private insurers who actually agree to pay their customers’ bills, even though the hospital is considered out-of-network by most insurance companies. “Most of our money still comes from the sporadic payments of commercial insurances,” Hashmi says.
Texas General’s expenses are not public because it is a for-profit operation. “I cannot describe to you our profits of the last fiscal year, but we barely balanced our expenses last year,” he says. “I do not take a salary from the hospital, but if there is money left, then that is my profit.”
After showing me the empty elective surgery check-in room, Hashmi and company take me to the rooms that doctors can use to perform procedures ranging from spine surgery, craniofacial surgery, bariatric surgery, pain-management, hand and foot surgery, gastroenterology procedures, orthopedic surgery and urology. They talk about their technological advancements like ionized floors in the rooms, hospital beds that can tell a patient’s weight and a sleep lab where a pulmonologist watches patients to determine if they have sleep apnea.
He’s not in today. “They’re here when necessary, when there’s a case given,” Wagley explains.
A gastroenterology suite, similarly boasting state-of-the-art technology and equipment, is also empty. “We usually do procedures between 7 a.m. and 9 a.m., so this area would be used in the morning,” Wagley says. They introduce me to several nurses on duty and tell me about the people who work as the board runner and the charge nurse. “They aren’t here. They’ve already done cases,” Wagley says.
In one of the X-ray rooms, a whiteboard chart that is supposed to list the names of patients is instead covered in doodles. A woman who works in the billing department says that she has never received any complaints about the hospital’s billing practices.
Hashmi and company show me the empty room where patients wait to be prepared for an upcoming surgery. No one is there, they say, because all of the surgeries took place in the morning. “Most of the time, on a busy day, this place is bustling,” Hashmi says.
Signs around the emergency room remind people that Texas General Hospital has a stroke program, and in an emergency suite, Hashmi finally has a chance to explain to me what this program entails. He points to a television screen next to the bed.
If a patient were to come into Texas General Hospital with a stroke, the hospital would dial up a neurointerventionist on-call at UT Southwestern. The doctor would then examine the patient and review copies of the patient’s CT scans remotely.
“They can see the patient, they can virtually examine their pupils, there’s communication back and forth," Hashmi says. "And they actually oversee what medications they're getting, how they’re responding, and what is going on.”
“There’s not going to be neurointerventionalists everywhere to go around, so we have telemedicine, so we can bring that specialty to the patient,” Wagley adds.
Eventually, however, after getting stabilized, the stroke patient would then have to be transferred to UT-Southwestern to see a doctor face-to-face. That will happen via helicopter, run by a contractor. A helipad is outside by the hospital building.
Women going through labor who visit Texas General Hospital will also need to be helicoptered elsewhere, because the hospital does not have an OB program. They are not sure how much this helicopter ride will cost patients or their insurers. “The helicopter service bills itself to their insurance,” Hashmi says. “In other words, we don’t have a code here to bill for that helicopter.”
Patients coming here for a medical procedure will find that they owe nothing to the hospital upfront, and may mistakenly believe it will stay that way.
Tony Wade suffered arthritis in his hands and feet for years. His doctor in Arlington two years ago scheduled surgery for him at Texas General Hospital. Wade remembers the hospital being strangely empty the day of his procedure.
Two years later Wade got a bill in the mail. “Please pay this amount: $332,346.60.”
Wade says his doctor, who had told him the surgery would cost $5,200, had not warned him that Texas General Hospital was out-of-network and therefore would likely not be covered by his Blue Cross-Blue Shield health insurance. An itemized bill he received from the hospital’s billing department upon request confirmed that the amount really was that high. Charges included $10,000 for “RECOVERY ROOM 1 HOUR.”
Texas General Hospital officials claim they tried 24 times to get his insurer to cover it before sending Wade the bill. “Because we’re an out-of-network hospital, we don’t just submit bills to insurance companies and then they pay it,” says Texas General Hospital CEO Roger Rhodes. "They deny it every time that we submit."
When Wade told the hospital’s billing department that he couldn’t pay, they emailed him a financial aid form in July and encouraged him to apply: “Please see attached Financial Benefit Form. Please complete and return back to me. Texas General is here to help you.”
But Wade says that Texas General Hospital’s financial aid form asks patients for the the name, Social Security number and birthdate of every dependent who lives in their household. The form also asks patients seeking aid for a list of all real estate they own, all of recreational vehicles they own, and all sources of their income.
Patients who don’t mind giving the hospital this information and agree to apply for financial aid anyway, are, according to the fine print, agreeing to “repay the full financial assistance award if I receive payment of any kind for the medical services covered by this financial aid application.” They are also giving the hospital permission to go after their debt: “Texas General Hospital is authorized to access credit bureau files and reports, now and in the future for collection purposes.”
Texas General Hospital’s executives outright deny that they will turn Wade’s bill over to collectors, even if he had agreed to sign away his rights. (After looking over the financial aid paperwork, he decided it wouldn’t be a smart idea to apply.)
Hashmi steadfastly denies that he has ever taken aggressive action to collect a debt. To the contrary, he claims that the reason that the bills at Texas General Hospital have gotten so high is because the hospital doesn’t take steps to collect money from customers.
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“You have to have high level of charges so that when you can get paid, you get paid slightly more than what you would otherwise get paid from the insurance, that is the idea,” Hashmi says. “If 30 percent of the people shopping at Wal-Mart decided not to pay, what would happen to Wal-Mart? They would have to recover somewhere. And that is what happened.”
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