September 5th, 2011 by Happy Hospitalist in Health Policy
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One of the worst parts of my job over the years has been to tell patients I was going to bring them into the hospital as an observation status because they did not have any criteria for full inpatient status. There is a huge difference in how CMS pays for hospital care (excluding critical access hospitals) between inpatient versus observation.
Observation is considered outpatient. Medicare will pay for observation hospital services for up to 48 hours to allow physicians a chance to observe the patient and determine if they need to have an inpatient hospital admission. Observation was never intended to be used as a holding pit to help social workers arrange for a nursing home transfer during normal business working hours because it can’t be arranged, on either end, at 10 pm on a Friday night.
What used to be a moral family obligation to care for loved ones too weak to care for themselves has now been relinquished to the role of hospitals and hospitalists. And we all pay for it. Families have abandoned their loved ones for good. It’s really quite sad. Bringing patients into the hospital for the purpose of arranging a nursing home transfer is, in my opinion, a form of Medicare fraud, since these patients have no intention of being fully admitted.
But it’s paid for and will always be paid for, except when Read more »
*This blog post was originally published at The Happy Hospitalist*
August 31st, 2011 by Toni Brayer, M.D. in Uncategorized
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I am smacking myself on the forehead and saying, “Why didn’t I think of this?” Dr. Richard Parker, Medical Director at Beth Israel Deaconess Medical Center, has sent out a list to his physician colleagues of 56 common medical tests and procedures. What is revolutionary is that there are prices next to each item. You non-physicians may be surprised to know that we doctors have no idea what the tests or drugs we order actually cost. Unless we get billed as a patient, we are as clueless as you are.
As I wrote before, the ostrich excuse just won’t fly any more. We all need to be aware of the cost of care and have skin in the game. Some will argue that price can’t be the only driver. I’ve heard physicians say you can’t compare one price to another because “quality” costs more. I say prove it. Read more »
*This blog post was originally published at EverythingHealth*
August 16th, 2011 by Happy Hospitalist in Opinion, Research
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Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study.
That’s the title of the latest medical study making the viral rounds. I had an opportunity to read the study in full. I called Happy’s hospital library and Judy had the pdf article in my email in less than 24 hours. Now, that’s amazing. Thanks Judy for a job well done. You deserve a raise.
Presented in the August 2nd, 2011 edition of the journal Annals of Internal Medicine, Volume 155 Number 3 Page 152-159, the study concludes that decreased length of stay and hospital costs associated with hospitalist care are offset by higher medical utilization and costs after discharge.
In summary, hosptitalist patients had an adjusted length of stay 0.64 days shorter and $282 less than patients cared for by primary care physicians, but total 30 day post discharge costs were $332 higher. These additional charges were defined as 59% from rehospitalization, 19% from skilled-nursing facilities, and 22% from professional and other services.
OK fair enough. Let’s come to that conclusion. Let’s say Read more »
*This blog post was originally published at The Happy Hospitalist*
July 22nd, 2011 by StevenWilkinsMPH in Opinion
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“I don’t have the time…I don’t get reimbursed for that.” This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.
I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork. Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact do not get paid for. Physicians do have it rough right now.
But Doctors Can Sometimes Be Their Own Worst Enemies
Currently, in just about every State, Read more »
*This blog post was originally published at Mind The Gap*
June 13th, 2011 by Dryden Epstein in Opinion, True Stories
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I graduated from medical school in 1985, am board certified in EM and practiced 25 years—mainly inner city/trauma/teaching centers. However, the last 5 years were in a rural 25-bed hospital, 60 miles from a shopping mall or hospital with higher capabilities and specialists. My hourly rate was competitive and the hospital provided benefits included: malpractice, health, dental, & vision insurance, prescription coverage, paid vacation/CME allowance, and pension contribution.
Palliative Medicine (intensive symptom management for chronic or serious illness, coordination of care and clarification of patient/family treatment & life goals) is a subspecialty in urban settings but is lacking and most needed in the rural community setting. The chronically ill patient who is also typically elderly may present to the ED and be denied hospital admission after an ED physician evaluation. The doctor can “request” admission from an at-home Utilization Review nurse who checks the admission guidelines and if not met, reports the patient is to be sent home—even if it is over the objections of the physician who has evaluated the patient. There is no systematic follow-up of these patients, and they are told to “contact your primary care physician.” No one is making sure this happens. Some do not have primary care physicians and may be unable to obtain a timely appointment. The hospital does not have a social worker to coordinate care or provide assistance in the confusing navigation of insurance/appointments/outpatient testing, etc. There is no 24-hour pharmacy. Many of these patients do not have transportation or no longer drive and often live many, many miles from the hospital relying on neighbors, church folk, or county ambulance when they become ill.
In 2010, I opened Read more »
