Chutzpa is one of those gem Yiddish words that loses something in translation. It means unmitigated gall, but when my parents’ generation used the word, it packed a lot more punch. In fact, they rarely used the word in isolation. They’d say, that takes real chutzpa, with an emphasis on real I’ve yet learned to master. The act of committing chutzpa is chutzpadik.

For this post I need to teach you an additional Yiddish word: chazer. Literally translated in means pig, and if the word is used to describe one’s eating habits, the expression is he eats like a chazer. The ultimate insult is if someone is characterized as a chazer without any food reference.

Here’s an example of a chazer: A hospital CEO who pays themself millions of dollars while laying off nurses and other healthcare workers and expecting the remaining staff to pick up the slack. A CEO who does this in the midst of a pandemic is a real chazer. Underscoring the brilliance of the Yiddish language, chazer is gender netural. A male hospital CEO chazer and a female hospital CEO chazer are both chazers. Thirteen percent of hospital CEOs are women, and the management of the American Hospital Association (AHA) is overwhelmingly female.

Melinda Hatton

I offer this Yiddish word primer to best communicate the unabashed chutzpa of a February letter the AHA sent to the Federal Trade Commission asking the agency to investigate the surging pricing of “travel nurse” staffing agencies. “Such outrageous rate hikes appear to be naked attempts to exploit the pandemic by charging supracompetitive prices to desperate hospitals,” thundered Melinda Hatton, the AHA’s general counsel.”

The letter, which I only just discovered, also asks the FTC to cancel its study of hospital mergers, arguing it wouldn’t be a good use of the agency’s resources during a pandemic. Hatton’s letter urges the FTC to turn its sights on UnitedHealthcare, accusing America’s biggest healthcare insurer of “creating consumer confusion” and a “new avenue” for surprise bills.

Don’t be deceived that the AHA is an altruistic organization committed to the betterment of hospitals and healthcare. It’s priorities these days are fighting price transparency rules introduced by the Trump Administration, so that their member CEOs can continue earning millions in compensation running their bogus “nonprofits.” If the AHA asked me to rebrand the organization so people could more readily understand its mission, I’d call it The American Association of Hospital CEO Chazers.

Nurse staffing agencies are indeed causing havoc for U.S. hospitals. The AHA’s members want the public to believe it’s due to Covid and nurses quitting because working during the pandemic took too much of a toll on them. That’s a lie. The shortage was predicted years ago because working as a nurse became a pretty crummy job. Hospitals increased their patient workloads, while limiting their pay and cutting their benefits. Underscoring the stress of the job, nurses commit suicide at a dramatically higher rate than the general population.

The vaccine mandates exacerbated the situation somewhat, but the nurse shortage train left the station long before Covid. As nurses increasingly got fed up and quit, hospitals turned to staffing agencies to fill holes in the schedules. To meet the demand, the staffing agencies recruited nurses with more generous compensation than they could earn working as a mistreated cog at a hospital. As the predicted nursing shortage took hold, the agencies had to pay more to recruit nurses to meet growing demand for their services.

Still, many nurses initially remained committed to their hospitals and patients. But they became increasingly concerned about aggressive cost cutting, often the result of hospital mergers. To remedy the situation, the nurses began to organize. Rather than address and assuage their concerns, hospital CEOs hired pricey union busting consultants to intimidate their nurses. Beaumont Health in 2019 spent nearly $2 million to intimidate nurses at its flagship Royal Oak hospital in suburban Detroit to prevent them from organizing. The campaign was so forceful the Michigan Nurses Association publicly vowed it wouldn’t never seek to organize a Beaumont hospital again because of the hospital company’s “climate of fear.”

Beaumont is headed by CEO John Fox. Remember that name. We’ll be revisiting with him in a moment.

LeQuitha Simmons

As best I can tell, nurse staffing agencies aren’t owned and management by private equity firms, the ultimate chazers in the healthcare kingdom. Rather, they are owned by entrepreneurial nurses like LeQuitha Simmons, who founded Nurses at Heart, a nurse staffing agency for long-term care facilities in Pennsylvania and North Carolina. A former traveling nurse herself, Simmons’ bio says she is a United States Army Veteran who served during the Iraq war.

Simmons isn’t a chazer looking to shut out competition. She’s published a primer for other nurses who want to get into the nurse staffing business.

Meanwhile, Beaumont Royal Oak is suffering a severe nurse shortage that has forced the hospital to close entire wards, straining the hospital’s emergency center because there are insufficient beds to admit patients. CEO Fox shamefully tried blaming the unvaccinated for the severely long waits at Beaumont’s emergency rooms when the problem stems from his mismanagement and aggressive cost cutting. Beaumont is looking to recruit nurses in Canada and the Philippines, as are other U.S. hospitals. According to Kaiser Health News, some states are assisting hospitals with their overseas recruiting costs, effectively rewarding them for their HR incompetence.

It’s galling that the AHA would accuse nurse staffing agencies of trying “to exploit the pandemic.” When Covid surfaced last year, the AHA and its members were warning that hospitals were in danger of failing. Among the loudest Chicken Littles was Beaumont’s Fox, who penned this op-ed in the Detroit Free Press warning about “healthcare’s looming implosion” and was repeatedly quoted in the media about the industry’s pending doom. Congress showered the healthcare industry with bucketloads of cash.

How did Beaumont fare in 2020? It added $1 billion to its already significant $2.5 billion reserve. Fox in recent years earned more than $6 million, despite a survey showing the majority of doctors in the hospital system had no confidence in him.

Fox is a former chair of the Michigan Health and Hospital Association. The current chair is Spectrum Health CEO Tina Freese Decker, who will take over battered Beaumont if the FTC approves the controversial deal. Based on a golden parachute paid to one of Fox’s predecessors, he stands to pocket more than $30 million if the deal goes through. Spectrum’s former CFO has publicly warned the deal could result in a “massive financial loss.” The reason the AHA wants the FTC to abandon a study of hospital mergers because its already well known they result in a decline in the quality of care and higher patient costs.

John Fox

There’s plenty of chutzpa to go around in the healthcare industry. The California Hospital Association in September asked the state attorney general to investigate nurse staffing agencies. California’s AG office already knows about the deleterious effects of hospital mergers and consolidations. The agency in August received approval for its $575 million landmark settlement with Sutter Health because of “anticompetitive practices” after it acquired a slew of hospitals in Northern California. Sutter is no stranger to the Department of Justice. In August, the hospital network settled for $90 million allegations that it submitted false claims.  

Sutter CEO Sarah Krevans earned nearly $5 million in 2018, according to the latest public filing I could readily find.

Another hospital CEO with shameless chutpza is Alan Levine, CEO of Tennessee-based Ballad Health, who accused nurse staffing agencies of “extracting enormous profits” and distorting hospital labor markets.  Ballad is the result of an unusual and controversial merger that gave Ballad a near monopoly in some parts of Tennessee. Here’s how things are working out for residents in rural Appalachia thanks to the merger.

Admittedly, the AHA’s concerns about UnitedHealthcare are well placed. A recent federal agency report says UHC’s parent received $3.7 billion in questionable Medicare payments in 2017. DOJ and state attorney generals have filed multiple lawsuits against UnitedHealthcare and its affiliates alleging Medicare billing fraud. UnitedHealthcare’s former CEO is a real chazer, earning about $42 million last year.

UnitedHealthcare, in turn, is suing TeamHealth, alleging the ER staffing company overbilled the insurer more than $100 million by inflating diagnoses and procedures that were performed. An affiliate of TeamHealth is suing UHC alleging the insurer didn’t pay the claims it was due.

TeamHealth is owned by KKR and was a pioneer in surprise billing. The company is a major provider of emergency room staff to hospitals. The AHA has no issues with surprise billing when its members benefit from it.

As I see it, among the few heroes in the healthcare industry are nurse staffing agencies who are increasingly driving up pay and improving working conditions for America’s hard-pressed nurses. It pleases me no end that they are disrupting the exploitive business practices of the MBA suits running American hospitals who only champion free markets if they can distort and manipulate them.

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