For years, there has been health insurance pressure on hospitals to more quickly discharge patients once it is felt that intense hospital-based care is no longer needed. We all hear patients and their families complain that patients are being pushed out of hospitals, either to return home or into nursing home or rehab facilities, before they are ready to cope with the aftermath of their illness. But the financial incentives are strong to discharge, and hospitals responded accordingly.
Now there is counter-pressure. A recent article in the Puget Sound Business Journal points out that a provision of the Affordable Care Act penalizes hospitals whose rates of “return” patients are considered too high. The article, titled “Hospitals get help so patients can escape the revolving door of readmissions,” is in the July 28, 2014 issue of the publication. This doesn’t necessarily mean that patients will be kept in the hospital longer, but it does mean that a discharge must take into account the outpatient care that is required to avoid a re-admission of the patient. Part of that may mean an additional day or two in the hospital as a plan is developed with the patient and family for outpatient care after discharge.
The problem of emergency room re-admissions was recently dealt with in a book, Bouncebacks!, by two ER physicians. The book chronicles stories of patients who were admitted to the ER, did not receive adequate diagnosis or care and were later re-admitted with a much more serious condition.
The authors point out that there is always financial pressure on ER personnel to quickly process and discharge patients, but the problem of re-admissions may mean much more in health care costs, both to the individual and to society. There is no question that monetary concerns are now a major driver of health-care decisions, and finding the right balance may be hard to attain. But the pendulum now seems to be moving toward the need for a more careful diagnosis and care plan, even if it means a slightly longer hospital stay, in part to avoid the costs of having patients become sicker and being re-admitted to the hospital.
