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The Revolving Door
Length of Stay vs. Re-admissions
This past June we featured the first in a series of Op-Ed articles discussing "The Revolving Door" issue.
Read on for Part 2
Click here to view the June article>
Hospitals are now under increased financial pressure from payors to avoid re-admissions, while also experiencing pressure to shorten admissions. A physician executive recently stated "As we advocate for shorter hospital stays, complete work ups are no longer completed in the hospital. Insurance companies advocate for discharge with the testing being pursued after discharge (denying payments for these days.)"
If the patient is discharged without a full work up, it is likely that they have not had full diagnosis or treatment, either; and no one knows if what they have had is sufficient. It is much easier for both physician and patient to finish the evaluation and treatment while the patient is in the hospital, available, and getting their medications. The cost of the hospital bed is largely incurred whether there is a patient in it or not. The increased costs of multiple visits to the doctor and hospital may well outweigh the actual increase in costs of keeping the patient to finish the evaluation.
However, it is reasonable to ask why someone who is not getting acute care is in the hospital, being "worked-up" for their chronic conditions. Hospitals are acute care facilities.
Our system has evolved in such a way that many people who would have been seen as outpatients are now seen in Emergency Rooms.
Patients should not be pushed to the Emergency Room after hours. 20 years ago if your child was sick, you took him to the pediatrician in your group that was on call. They knew the child or had his record. Primary care worked the same way. Today primary care offices close at 5P, just as people have time to seek treatment for minor illness. The ER is the most expensive and inappropriate place for these patients.If they have a condition requiring admission, treatment of that condition will probably require a complete evaluation of their health. With hospital stays of 1-5 days, the evaluation may well not be complete by discharge. The end result is that the patient receives a very expensive evaluation that may not be necessary and may never be used after discharge.
The same physician went on to say "Discussions about informed consent and patient autonomy don't seem to convince our physicians especially if the patient is non-complaint even in the hospital or doesn't have the money or time for an outpatient work up." We think patient and family time and expense should be part of the equation. The chance of actually finishing the evaluation and using the results is much better if the client remains in the hospital. They are often in rough shape when they go home and not likely to come back.
Continuity of care is paramount. Outpatient records should be available within the Emergency Room and vice versa. The patient and their family should always insure that they and the patient's physician understand what will be required when they go home and that it will be available. Sending a senior home alone, weak, and confused is not acceptable.
About Home Instead Senior Care:
Home Instead Senior Care of Northborough and Natick are two in a network of 17 locally owned offices in Massachusetts - from Greater Boston, the Cape and Western MA, to the Metrowest, Southern and Northern suburbs - dedicated to providing high quality, trusted home care to help seniors remain in their homes as they grow older. For those who have chosen to age at home, HISC can be the difference between counting the years and living them. Services are also available to seniors living in facilities.
To learn more about Home Instead Senior Care of Northborough and Natick, please visit www.hearthside-homeinstead.com.
Home Instead Senior Care: Trusted Care for the Senior You Care For
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