On September 25, the CEO of the Ribera Group, Pablo Gallart, asked in an internal meeting revealed by EL PAÍS to around twenty executives to increase waiting lists and select profitable processes to increase EBITDA (profit before interest, taxes, depreciation and amortization) of the Torrejón de Ardoz Hospital, a private public center in Madrid. He and the president of the community, Isabel Díaz Ayuso, tried this Saturday to discredit the information, saying it was out of context. This newspaper now publishes Gallart’s full intervention. Nothing he says in the 24 minutes and 56 seconds of recording contradicts what EL PAÍS has published so far. The whole context is the justification he gives to persuade his subordinates to take the actions he asks of them after the fact. “What we are going to do is obviously adapt the service that we are going to provide them according to the money… and the resources that they are going to give us,” he explains after having pleaded for losses of a million dollars due to the agreement with the Community of Madrid.
Before publishing the news, this newspaper had already verified with the full audio that the instructions were true and verified how these directives were then expressed in writing. He also repeatedly asked Ribera to speak with Gallart to show him all the material, comment on it and contextualize it as he deemed appropriate, but he refused to do so through a spokesperson. In his statement on Saturday, the CEO alluded to an hour and 25 minutes of meeting, but sources present indicate that after his first intervention and a series of questions, he left and the meeting continued without him.
The context to which Gallart refers was briefly reflected in the first information of EL PAÍS, of December 3, in which it was already explained that the director justified the reductions by the lack of profits of the hospital. The CEO begins his speech by exposing this bad situation and accuses the Community of Madrid of not paying enough: “We lose 20 million per year because the capital they paid us is much lower than the service we provided (…). We had to take a stand or give them one last chance to settle the contract. They accepted the balance we expected, 17 million per year, and they only gave us half of it, around nine. But hey, it’s true that we saved money. match ball“.
Gallart is referring here to the rescue of 33.7 million euros that the Community of Madrid approved last July to clean up the company’s accounts. They have added additional contributions to the 88 million contract over the past five years. The debt declared by the group for its investment in Madrid reached 124 million euros in 2022.
Before giving the orders revealed by EL PAÍS, to increase the waiting lists after having lowered them for two years and to identify the processes that “do not contribute to EBITDA”, Gallart justifies them: “The Administration, recognizing these nine (millions), in one way or another, what it has told us, are the resources that we will have in the future, and we, as a company engaged in the service, what we are going to do is obviously adapt the service we are going to give them according to the money or resources we have available. they will give it to us. Ultimately, unfortunately, resources are something that is limited for any business.
Gallart assures that historically his hospital has provided a service “of much better quality than the public service”. “You always have a small profit which is, let’s say, the return that we receive as an operator,” he explains, so that his audience understands the “situation”. He says they are “infinitely better than 12 months ago but much worse than we would have liked”.
Gallart tells his collaborators that the hospital will not make money until the end of the concession: “I have convinced the French that it is impossible for Torrejón to make money by 2039. It is not possible. And Vivalto (the parent group, based in France) adheres to this idea (…) What Vivalto needs is that the net cash generated annually is not negative,” he says, later asserting that the company transferred “the entire investment to the Administration”.
The operating concession for this hospital is on a “risk and chance” basis. In other words, making money is not guaranteed and losing it is an option when investing.
Another justification put forward by Gallart for the reductions he proposes is that the Community has not accepted that all internal resident doctors (MIR) are paid by the Ministry of Education “which is logical and what happens in other autonomies”. “If they had accepted that we assume MIRES, we would say that the five or six million that we need and that I am asking for here, we would already have them,” he said.
Increase waiting lists
After a financial explanation, he gives the slogans that have spread about the increase in waiting lists: “What is our management capacity? 23, we decided as an organization to make an effort to reduce the waiting list. The only thing I ask is: let’s get back on track.
Gallart asks to be placed below public waiting lists, but tells his commanders that “it is not necessary to obtain an honors degree.” For hospitals that have this type of agreement with the Administration, it is important to keep their lists below those of nearby centers. The company charges a fixed fee for treating patients in its area and additional revenue for each procedure it captures from the population of other areas.
The CEO states that what is discussed at the meeting is how to ensure the survival of “Torrejón”. The conversation takes place against the backdrop, as this newspaper published, of the French group’s request to clean up its accounts with a view to selling shares in the company next year.
“We all like to grow, provide any expensive service that we would all be happy with, in short, offer the best, wait as little time as possible, provide the best technology. We don’t have a budget for that,” he emphasizes.
And then Gallart adds: “I’m convinced we’re going to get there. As easy as it has been in the past to increase personnel costs by four or five million to increase or decrease the waiting list, it doesn’t occur to me that it’s not as easy to go the other way, in fact. Elasticity always goes both ways. And I’m not just talking about waiting lists, I’m sure you have a lot of imagination, I’m sure you’re capable to identify which processes do not contribute to the success of the company (profitable) EBITDA and which processes, and which activity interests us the most (…) We surely do a lot of non-resident activities which do not contribute to us, that is to say which harm us.
After these orders were transmitted, written instructions were given to reject “non-capita” patients, such as those on peritoneal dialysis, from the hospital. Written orders have also been drafted to reuse single-use medical supplies, such as catheters used for cardiovascular procedures.
“Torrejón will never be a business and we told the Administration that (…) We did not come here to make money,” he explains at the end of his speech. Before question period, the CEO assures that he could embellish the situation by saying that “it’s phenomenal” that they were given 200 million for rebalancing. “But maybe we needed 300,” he emphasizes. “We saved the match ball,” adds Gallart. “Let’s finish the play now.” Gallart asks his commanders to “guarantee quality service”. “It’s possible that Torrejón will be our biggest challenge,” he told them.
About The Author
