Hospitals want doctors to admit more patients for revenue

[vbgal41]

Interesting segment from 60 minutes. Hospital administrators want doctors to meet quotas for admitting patients even if it is not medically necessary. Thoughts?

http://www.cbsnews.com/8301-18560_162-57556670/hospitals-the-cost-of-admission/

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[AxiomaticTruth]

Interesting segment from 60 minutes. Hospital administrators want doctors to meet quotas for admitting patients even if it is not medically necessary. Thoughts?

http://www.cbsnews.com/8301-18560_162-57556670/hospitals-the-cost-of-admission/

To be honest, I'm not sure there's anything overall wrong with that.

Health Management Associates owns 70 hospitals in 15 states. It's thrived buying small, struggling hospitals in non-urban areas, turning them into profit centers by filling empty beds. Generally speaking, the more patients a hospital admits, the more money it can make, a business strategy that HMA has aggressively pursued.

If the hospitals are struggling in the first place financially, is it better to let them shut down and leave a void? Or is it better to be bought out by a private company to bring in more patients to prop up the non-profitable hospitals in the company and bring service to rural areas? I mean sure the company is taking advantage of insurance (medicare, medicaid, etc), which ultimately raises the rates on us. I'm just saying it isn't so "omg private business is bad!" black and white.

 

[StudyShy]

As a case manager in an ER and in close contact with my hospital's CFO, we definitely do not promote admissions that are not medically necessary. They are bad in the long run for hospitals. Part of my job is to see how they can be safely discharged home or back to the nursing home. Reducing the readmission rate is also of high priority.

If a patient does not meet at least observation under Interqual guidelines, I'm definitely talking with the doctor to see if something more needs to be documented, see if I missed something pertinent, or if something additional needs to be ordered to meet the intensity of service.

That being said, there is on occasion, social cases where we need to keep the patient for their safety but they may not have anything medically wrong.

 

[supermario21]

I think this is an overstated problem trying to mobilize public opinion against doctors and hospitals. I remember 60 minutes doing a similar piece maybe 6 months to a year ago. What industry doesn't have ANY fraud? The true troublemakers will be punished without these hit pieces designed to make every doctor and hospital look bad.

 

[VictorAlpha]

As a case manager in an ER and in close contact with my hospital's CFO, we definitely do not promote admissions that are not medically necessary. They are bad in the long run for hospitals. Part of my job is to see how they can be safely discharged home or back to the nursing home. Reducing the readmission rate is also of high priority.

If a patient does not meet at least observation under Interqual guidelines, I'm definitely talking with the doctor to see if something more needs to be documented, see if I missed something pertinent, or if something additional needs to be ordered to meet the intensity of service.

That being said, there is on occasion, social cases where we need to keep the patient for their safety but they may not have anything medically wrong.

I think I agree with this. I have been working in a hospital pharmacy for a few years now and I think, someone can correct me if I'm wrong, but I think that there are new or maybe older rules that make unnecessary re-admission a more serious financial burden on health care institutions.

 

[Lya]

As a case manager in an ER and in close contact with my hospital's CFO, we definitely do not promote admissions that are not medically necessary. They are bad in the long run for hospitals. Part of my job is to see how they can be safely discharged home or back to the nursing home. Reducing the readmission rate is also of high priority.

It might be a dumb question, but why is it bad in the long run for hospitals? Or is it bad in the long run for hospitals so long as there is consistently a certain percentage (say, 10-20%) of patients who are admitted?

To take an extreme case scenario, isn't it less profitable for hospitals who don't admit patients at all, compared to available beds they have? I was just curious.

 

[LiveLoveLearn]

I think I agree with this. I have been working in a hospital pharmacy for a few years now and I think, someone can correct me if I'm wrong, but I think that there are new or maybe older rules that make unnecessary re-admission a more serious financial burden on health care institutions.

This is true, at least for government payers (Medicare/Medicaid). They have to report on readmissions, and can be penalized. Additionally, if a patient is "admitted" for inproperly, and subsequently discharged without triggering 2 nights of bed charges, most institutions have a "one day stay committe" or something of that nature to review the stay to determine if it is medically necessary. If it is found not to be, it is written off. They do this, because one day stays (which medically unnecessary admissions would be more likely to end up as) are heavily monitored by CMS.

Do hospitals want their admissions to be high and their beds to be full? Yes, but they face so much government oversight and potential back-lash for inappropriate admissions that most have many layers of review to ensure that these types of situations don't occur (or don't get billed when they do).

 

[survivordo]

Not surprising that the financial director of the ED is also the doc that seems to admit the most patients...

Survivor DO

 

[circulus vitios]

Why do hospital administrators have any say in matters of clinical medicine? Chain them to their cubicles and feed them scraps.

 

[Lucky Louie]

This is like policemen who have a quota on how many tickets they give out in a month. The real tragedy is that some people actually get worse when they stay in a hospital.

 

[911 Turbo]

Why do hospital administrators have any say in matters of clinical medicine? Chain them to their cubicles and feed them scraps.

Rofl. Strong ignorance in this post