For the fourth consecutive year, U.S. News & World Report has named University of Virginia Children’s Hospital the top children’s hospital in the commonwealth.
But this year, the accolade has been awarded amid allegations that the UVa Health System has been fraudulently billing patients, mistreating employees and retaliating against those who speak out against administrators.
“When I hear things like, ‘All these hospitals, their quality scores are great,’ there’s no way,” said a former UVa Health executive, who spoke with The Daily Progress under the condition of anonymity. “There is absolutely no way that that can be true, because to drive that kind of result requires you to focus on the very things that he destroyed.”
The executive was referring to their former boss: UVa Health CEO Dr. Craig Kent. Kent, along with UVa School of Medicine Dean Dr. Melina Kibbe, was the subject of a Sept. 5 letter of no confidence signed by 128 hospital physicians and medical school faculty. The five-page document claims the pair have committed a number of “egregious” and illegal acts and created a toxic work environment that has reached the point of endangering patients.
Since the letter was delivered to UVa administrators, The Daily Progress has interviewed more than a dozen former and current hospital executives and physicians as well as medical school faculty members, all of whom agreed to speak under the condition of anonymity and all of whom agreed that UVa Health’s top priority has become “money and reputation.”
Others in the UVa community agreed with that assessment.
“The competition and the pressure to game the metrics of the ranking systems causes administrators to lose sight of what they’re really supposed to be doing,” associate professor Walt Heinecke, who leads the university’s chapter of the American Association of University Professors, told The Daily Progress. “They drive people to make poor decisions that I think are part of the problem at the hospital and at the School of Medicine.”
A significant share of those problems detailed in the letter of no confidence focused on a “culture of fear and retaliation” which the signatories claim Kent and Kibbe created at UVa. The pair are accused of wielding promotions — as well as explicit threats — as a means to retaliate against those who challenged them.
One of the allegations in particular calls out the university for an obsession with rankings — and doing whatever it takes to achieve them.
“Disregarding valid reports of fraudulent billing and requests by senior leaders to fraudulently modify patient records in order to obfuscate adverse outcomes and boost productivity metrics,” reads the letter.
Over the course of investigating the claims of fraud at the hospital, The Daily Progress interviewed multiple subjects who expressed their misgivings regarding the authenticity of the metrics UVa Health administrators submit for rankings.
The former hospital executive who spoke with The Daily Progress spent nearly a decade at UVa Health prior to Kent’s arrival in February 2020, but left less than a year later, because “I could not in good conscience work for him knowing that there were no checks and balances.”
“If there’s quality data going out there … there’s no question that he would have been just fine with them manipulating [the data],” they said.
They recalled a meeting they were a part of during the pandemic to discuss the amount of financial aid the state was allocating to hospitals. Money was distributed based on the number of patients each center was treating. According to the former executive, when Kent was told at the meeting that another, slightly larger, health system in the commonwealth would be receiving more funds, his response was: “I don’t care what you have to do to work the numbers. We are going to get as much money as [the other hospital] is.”
UVa physicians told The Daily Progress that another way the hospital has been able to “obfuscate adverse outcomes and boost productivity metrics” is through its clinical documentation initiative.
A program first mentioned by the UVa School of Medicine in April of 2023, UVa Health began to prioritize documenting all patient diagnoses on medical charts when it came time to submit those records for external reviews. In a statement announcing its decision to adopt the practice, the medical school acknowledged including a patient’s entire medical history could have an impact on metrics.
“One of the reasons external benchmarks don’t reflect our excellent mortality is that we don’t always document and code our very ill patients with the diagnoses necessary to accurately and comprehensively reflect their high severity of illness and risk of mortality,” reads the School of Medicine announcement. “This can be rectified, but it requires a partnership between our physicians who create the medical documentation and the nurses and coders who transfer that information into codes for each patient.”
However, these measures have little to no effect on the actual treatment of sick patients, the physicians who spoke with The Daily Progress said. According to those physicians, UVa Health administrators regularly pressured physicians to go back into charts to fill in diagnoses the medical personnel had deemed irrelevant to the treatment they administered, even after patients had already gone home or no longer required care.
“They’ll just say, ‘Oh, we’re just trying to accurately reflect how sick the patient was,’” one physician told The Daily Progress. “It has nothing to do with good patient care, patient safety or outcomes — has nothing to do with it all. It has to do with getting more money per patient, because you get more money per patient the sicker they are and to make the patients sicker in these benchmarking schemes.”
One reason UVa Health was eager to improve its metrics is because it would improve its national rankings, one physician said, including in U.S. News & World Report and Newsweek.
The Children’s Hospital of Richmond at Virginia Commonwealth University and Inova L.J. Murphy Children’s Hospital in Annandale came in second and third, respectively, in U.S. News & World Report’s “Best Children’s Hospital” rankings this year. The publication also ranked eight of UVa Children’s specialties in the top 50 of all children’s hospitals nationally, including neonatology, pediatric nephrology, and pediatric cardiology and heart surgery.
“Whatever positive rankings come out about these, about any hospital really, is probably due to the quality of the doctors that are there,” said Heinecke. “I worry that administrators who are trying to gain rankings lose sight of what’s the best thing to do for a patient.”
The writers of the Sept. 5 letter expressed this same fear for compromised patient safety, saying the document was a means of “last resort out of urgent concern for our patients, colleagues, community and the University of Virginia.”
If the 128 signatories had hoped that their pleas would spur UVa President Jim Ryan or the school’s governing Board of Visitors to immediately address the allegations, they were swiftly disappointed. Ryan’s initial response was to dismiss the claims as “generalized and anonymous claims of wrongdoing” from a small group of disgruntled faculty, typical of any organization.
Though he asserted that Kent and Kibbe are the reason the university health system “is in the best shape it has ever been in,” Ryan and the board did bring on the Washington, D.C.-based law firm of Williams & Connolly, recognized as one of the world’s premier litigation firms, to probe the complaints.
Despite assurances that the firm would be conducting an independent review that could clear the air, the university has already said the findings will not be released to the public.
The Daily Progress reached out to UVa Health regarding its physicians’ specific claims. A UVa Health representative did not respond, but official UVa spokesman Brian Coy did — with a prepared statement saying the university will not be commenting on the matter while the Williams & Connolly review is ongoing.
“In the interest of fairness to all parties, the university will not have further public comment while the review is proceeding,” reads Coy’s statement. “We encourage all interested faculty members to participate in this independent effort.”
Source: www.dailyprogress.com
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