HCA Healthcare
HCA Healthcare is an American for-profit operator of healthcare facilities that was founded in 1968. It is based in Nashville, Tennessee and, as of May 2020, owns and operates 186 hospitals and approximately 2,000 sites of care, including surgery centers, freestanding emergency rooms, urgent care centers and physician clinics in 21 states and the United Kingdom.
By conducting large-scale clinical research with partners including the Harvard Pilgrim Institute and the CDC, and using data gathered from their patients, HCA Healthcare has published several medical studies in peer-reviewed journals, including the REDUCE MRSA study published in the New England Journal of Medicine.
The company engaged in accounting and other practices in the 1990s that resulted in the payment of more than $2 million in federal fines and other penalties, and the dismissal of the CEO by the board of directors. New management turned the company around, and HCA Healthcare was named one of the world’s most ethical companies from 2010 to 2019 by the Ethisphere Institute.
History
Early years
HCA was founded in 1968, in Nashville, Tennessee by Dr. Thomas F. Frist Sr., Dr. Thomas F. Frist Jr. and Jack C. Massey. The founders envisioned a company that would bring together hospitals to deliver patient-focused care while using the combined resources of the organization to strengthen hospitals and improve the practice of medicine. The company began with Nashville's Park View Hospital, which the elder Frist had founded in 1960 with other doctors and where he was serving as chief executive.The company included 11 hospitals when it filed its initial public offering on the New York Stock Exchange in 1969 and had 26 hospitals and 3,000 beds by the end of the year.
Growth and merger
The 1970s were characterized by rapid growth in the industry and for HCA Healthcare. In the early 1980s, the focus shifted to consolidation with HCA Healthcare acquiring General Care Corporation, General Health Services, Hospital Affiliates International and Health Care Corporation. By the end of 1981, the company operated 349 hospitals with more than 49,000 beds. Operating revenues had grown to $2.4 billion.In 1987, HCA Healthcare, which had grown to operate 463 hospitals, spun off HealthTrust, a privately owned, 104-hospital company. Believing its stock was undervalued, the company completed a $5.1 billion leveraged management buyout led by chairman Thomas F. Frist, Jr. in 1988. HCA Healthcare re-emerged as a public company in 1992. In February 1994, HCA Healthcare merged with Louisville, Kentucky-based Columbia Hospital Corporation, which earlier had acquired 73 hospitals of Galen Health Care from Humana, to form Columbia/HCA.
Recent history
On November 17, 2006, HCA Healthcare became a private company for the third time when it completed a merger in which the company was acquired by a private investor group including affiliates of Kohlberg Kravis Roberts and Bain Capital, together with Merrill Lynch and HCA Healthcare founder Dr. Thomas F. Frist, Jr. The total transaction was valued at approximately $33 billion, making it the largest leveraged buyout in history at the time, eclipsing the 1989 buyout of RJR Nabisco.In May 2010, HCA announced that the corporation would once again go public with an expected $4.6-billion IPO. In March 2011, HCA sold 126.2 million shares for $30 each, raising about $3.79 billion, at that time, the largest private-equity backed IPO in U.S. history.
In December 2018, a historical marker was installed in the parking lot of HCA's Sarah Cannon Cancer Center in Nashville, formerly the location of HCA's first hospital, Park View Hospital.
The company was ranked No. 67 in the 2019 Fortune 500 list of the largest United States corporations by total revenue.
Facilities
United States
, HCA operated 186 hospitals and approximately 1,800 sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics located in 21 U.S. states and in the United Kingdom. In July 2007, HCA sold its hospitals in Switzerland.As of 2018, HCA had 50 hospitals and 31 surgery centers in Florida. In Texas, as of 2018 it had 53 hospitals. In Tennessee, where it began, it had 13 hospitals as of 2019.
Between 2003 and 2017, HCA did not enter any new markets; in 2017, it acquired the Memorial University Medical Center in Savannah, Georgia which added to its existing seven hospitals in the state. In 2019 it purchased Mission Health System which operates hospitals in North Carolina.
In 2017, it acquired three Houston hospitals from Tenet Healthcare.
In January 2020, HCA Healthcare acquired Valify, a healthcare cost-management company.
In May 2020, HCA acquired 49-bed Shands Starke Regional Medical Center and 25-bed Shands Live Oak Regional Medical Center from CHS. HCA is operating the two facilities as off-campus emergency departments of Lake City Medical Center and North Florida Regional Medical Center in Gainesville.
United Kingdom
The main hospital sites within the United Kingdom include:- The Christie Private Care
- 52 Alderley Road, Manchester
- The Harley Street Clinic
- HCA at The Shard
- The Lister Hospital
- London Bridge Hospital
- The Portland Hospital for Women and Children
- The Princess Grace Hospital
- The Wellington Hospital
The Princess Grace Hospital specializes in breast cancer and surgery, aided by Professor Kefah Mokbel and Dr. Nick Perry who, in 2005, founded The London Breast Institute.
Significant Areas of Operation
Medical Education
In recent years, HCA Healthcare has become a significant provider of clinical and medical education. It is the largest sponsor of graduate medical education programs in the U.S., with 56 teaching hospitals in 14 states, primarily in regions with a deficit of physician training programs. The company includes Research College of Nursing and Mercy School of Nursing, and has several advanced nursing simulation training centers. In early 2020, it completed the purchase of a majority stake in Galen College of Nursing, which operates five campuses and offers Bachelor of Science and Associate of Science nursing degrees.Stroke Care
HCA Healthcare treats approximately 50,000 stroke patients annually at 31 recognized comprehensive stroke centers. The average time between a patient’s arrival and receiving needed medication as of November 2019 was 42 minutes—30% faster than the national standard.Maternal Safety
HCA Healthcare delivers nearly one of every 17 babies born in the United States, more than 219,000 in 2019. Maternal mortality at HCA Healthcare hospitals was less than half the national rate in 2019. March of Dimes is a national partner of HCA Healthcare.Enhanced Surgical Recovery (ESR)
HCA Healthcare has developed an ESR protocol that reduces recovery times, complications and opioid use after surgery. Based on data collected from nearly 50,000 joint replacement, gynecologic oncology, colorectal and bariatric surgeries from January 1 – December 31, 2019, the HCA Healthcare ESR protocol reduced average length of stay by 3.63 days, resulting in nearly 59,000 fewer days in the hospital for its patients recovering from surgery. In 2019, HCA dispensed 1.57 million fewer morphine medications to surgery patients, a 50% decrease in total morphine equivalence per encounter.Workforce Education and Support
HCA Healthcare invests in workforce education and leadership programs for its approximately 280,000 employees and affiliates, including 98,000 registered nurses and 47,000 physicians.HCA spent $70.8M in student loan assistance, tuition reimbursement and certification support through its voucher program in 2019. The HCA Healthcare Hope Fund provides financial support to employees suffering hardship due to natural disaster, illness, injury, domestic violence, the death of a loved one or other unavoidable circumstance. The fund distributed $7.7M in 2019 and has provided $56 million in support since 2005.
Community Engagement
HCA Healthcare supports local communities through the HCA Healthcare Foundation and HCA Healthcare corporate sponsorships, as well as through the grassroots efforts of employees and affiliates. The company provides support for childhood and youth development programs, scholarships, community-based health clinics and the operating budgets of not-for-profit organizations. HCA Healthcare provided $45 million in charitable contributions across the United States in 2019.Legal Liabilities
In 1993, lawsuits were filed against HCA by former employees who alleged that the company had engaged in questionable Medicare billing practices. In 1997, with a federal investigation by the FBI, the IRS and the Department of Health and Human Services in its early stages, the Columbia/HCA board of directors forced Rick Scott to resign as chairman and CEO amid growing evidence that the company "had kept two sets of books, one to show the government and one with actual expenses listed." Thomas Frist, a co-founder of HCA and brother of U.S. Senator Bill Frist, returned to the company as CEO in 1997 and called on longtime friend and colleague Jack O. Bovender, Jr. to help him turn the company around.The federal probe culminated in 2003 with "the government receiving a total of over $2 billion in criminal fines and civil penalties for systematically defrauding federal health care programs." Columbia/HCA pleaded guilty to 14 felonies and admitted to systematically overcharging the government. The federal probe has been referred to as the longest and costliest investigation for health-care fraud in U.S. history.