For-Profit Hospitals Pushing Patients Out Too Early: Report

Hospital patients, unready to go home, are being pushed out the door anyway.

Pressure to meet financial obligations is pushing large hospitals to release patients too early, according to a pair of studies from University of Maryland Professor Bruce Golden. Patients that were discharged during hospitals' busiest periods were 50 percent more likely to come back to the hospital within three days, the study found.

One of the reasons for the rush to discharge patients: surgeons and hospitals operate on an incentive-driven model that pushes them to perform as many surgeries as possible, Golden said in a press release accompanying the findings.

"The hospital has to maintain revenue levels to meet its financial obligations. Surgeons are working to save lives and earn a livelihood. It's what they do," Golden said. "If the hospital says 'sorry there are no beds available,' there's a lot of tension and pressure from both sides to keep things moving."

That pressure appears effective. A 2010 survey from Forbes of America's most profitable hospitals found that more than 20 hospitals with over 200 beds make 25 cents on every dollar of patient revenue they take in. At the same time, Americans are paying the most for their health care of any industrialized nation, yet aren’t receiving the best care for their money, according to a study released earlier this month.

Seniors in Ontario are even being sent home from the hospital while they're still sick, the Ottowa Citizen reports. They're also being pushed out of the hospitals without adequate rehabilitation or therapy services.

The problem of sending patients home too early isn't limited to the U.S. though. The United Kingdom's National Health Service faced a scandal in 2010 after it was reported that the agency released 500,000 patients every year that were later readmitted because they were sent home too soon, according to Express.

Comments

[pixelated soul]

12:30 AM on 06/24/2012

This has nothing to do with hospitals being for profit or not, non-profits do the same thing and so do hospitals in Canada and the UK as your own article says. Why? Because your hospital being completely full results in massive government penalties for not being an available facility for sick people to go to and on top of that you also lose money like crazy, and non-profits can still easily go bankrupt.

[fortressfountain]

09:59 AM on 05/16/2012

The left is a victim? I heard a ceo of a bank whining banking is discriminated against. Corporations say they cannot profit because of regulation and uncertainity.

[iPaulHD]

09:59 PM on 05/15/2012

This article does not make any sense. Providing healthcare in the US is becoming more and more difficult as CMS has moved to value based purchasing, which requires that multiple quality of care initiatives and patient satisfaction scores need to be met. If not met, the amount of reimbursement the hospital receives is reduced.

Ironically, one of the soon to be required initiatives involves the same penalty for patients who are readmitted to the hospital too soon after discharge.

Does anyone here know what a DRG is? A DRG is what a hospital is paid, sort of a flat rate, for each admitted patient. The flat rate (usually about $5k) does not change, no matter what tests or services a patient receives. Simply, a patient with a broken hip requiring surgery and 3 days in the hospital pays the same as another patient who has a life threatening illness and is in intensive care for 3 weeks.

[ftworth texan]

06:38 PM on 05/15/2012

For the left to succeed, they need "victims"[tm].

[Mac Howard]

09:25 PM on 05/15/2012

And the right provides them with many ;)

[ftworth texan]

09:55 PM on 05/15/2012

The left creates "victims" when they don't have them. It's a title they love to hand out.

[papapj]

09:29 PM on 05/15/2012

For the right to succeed, they need brain-dead adherents...

[ftworth texan]

09:55 PM on 05/15/2012

Awe, you got your "feelings"[tm] hurt. Get ready for a lot more.... SCOTUS will school Obama on his ObamaCare. rofl

[ftworth texan]

06:12 PM on 05/15/2012

Everyone in the world still comes to the US for healthcare, when they can afford it.

Liberals would like to pull it down into a socialist utopia.

"All men are equal, some more equal than others."

[Anne Rutherford]

05:08 PM on 05/15/2012

So much is decided by the insurance companies. They have detailed reports that state for this surgery, you can discharge immediately with oral medication at home. If you require something different, you have to justify why to the insurance company, not that they will tell that to the patient or the hospital until after you missed the discharge date. Guess what, the insurance company won't pay, you get stuck with a bill - and just like Workman's Comp, if you appeal, the state will review, and generally rules in favor of the insurance company. Bottom line - $11,000 in bills to be paid by the patient - even though you didn't ask for them to be kept in hospital. It is all in how the reports are written, the codes that are used. Yet, one month later, DH was back in the hospital, needed a PIC line and had to be in a rehab facility for 2 plus weeks - in part because the oral medications failed (and some of it was a hospital acquired infection). Oh yes, when I retire, it's medical bankruptcy for me - but because of medication costs - can't retire until DH dies. Free market health care is myth, and what we have sucks.

[CmdrAdama]

05:04 PM on 05/15/2012

I'm comforted to hear about all of the hospitals seeking profits.

[TinyDancer1]

01:36 PM on 05/15/2012

That's what happens in a capitalist country when the hospital has to make a profit.

[anothersarah]

12:07 PM on 05/15/2012

this has been going on for years, but as a nurse and patient I see both sides. last year my sister was in the "recovery room" after surgery for 3 days because they didn't have a bed on the regular hospital floor.

[tired of being outraged]

11:27 AM on 05/15/2012

Some years ago I began to document, the daily (or rather - on an hourly basis) outrageous incidents occurring on my watch as a bachelor's level RN. I intended to publish a book as a catharsis. After about 50 pages, the task became so overwhelmingly depressing that I eventually gave up the project. The major contributors to our demise as doctors and nurses are both the administrative and corporate entitities. Direct care under-staffing in particular puts the patient in immediate danger. Of course, there are also a percentage of lousy nurses and doctors that should never have even made it through training - I have seen horrific malpractice which I reported - the posting space herein allows only two minor examples as follow:- A doctor who invariably did not even place his stethoscope ear pieces, when examining patients, as witnessed by all the staff - left it hanging around his neck while instructing the patient to take deep breaths. Nurses who failed to correctly run critical drips through incompetence and lack of commitment. It is the competent staff who burn out through the stress of trying to provide good care in the face of so much adversity. Yes, reader Bibbo, we need to fight back and take big business out of health care - perhaps we should all refuse to work for the corporations and develop smaller, managed by health professionals, services. The corporations are making huge profits at the expense of health service providers sanity and well-being and, sadly,

[TinyDancer1]

01:38 PM on 05/15/2012

And they claim we are a Christian country. Such a shame.

[cdianek]

11:26 AM on 05/15/2012

I think part of this - a deep, dark secret part - is intentional. If you send somebody home too early, when they roll back in, they're sicker and require even more expensive care. The problem with this business model is that if they can't afford to pay for the original procedure, how on earth will they be expected to pay for the corrective care. It's not really helping in the long run.

I think there's some movement afoot to curtail this. I remember - but can't cite directly - some wording in the CMS/Medicare/Medicaid literature that's curtailing reimbursements for readmissions within a certain time frame of a discharge. In other words, if a hospital boots you too early, and you have to go back in, the cost of the care is not billable to those entities. That, too, is not going to help in the long run - if they can't bill Medicare/Medicaid, they're gonna come after you, and either you or them is going to suffer from paying or not paying. But the idea is to keep you until they're sure you're not going to cost them more if you turn back up sicker.

It's just yet another problem with the bloated, ineffective method of health care delivery in this country. The care? Is great. The getting the care? Is an absolute mess.

[anothersarah]

12:05 PM on 05/15/2012

and Medicare won't pay for the original stay if they come back in too quick! (my sister & I are both nurses.)

[allmywickedsins]

06:25 PM on 05/15/2012

I hate to agree, but you may be right about it being intentional so they'll come back sicker. I've seen it with a family member this past year. They keep sending her home when it's clear she's not ready, then she has to go back just as sick..if not sicker...a week later. Poor woman has had to go back three times now, at 85 it's hard on her.

[freeSpeakr]

11:03 AM on 05/15/2012

Turnover!!!! WE NEED TURNOVER!!!! GET OUT!!!!

[Both Wings 2 fly]

10:01 AM on 05/15/2012

Repeat but still relevant:
“My friend and I were in a special ops unit, that later became Rangers in Viet Nam. He is a true right winger and I am more pragmatic, so our discussions, of course have always been interesting.
The beginning of this week he went to the hospital with trouble breathing. He went into ICU with heart problems. After two days, his mis-managed care company, called his doctor four times in one day, forcing him to go from ICU, to home, without a 24 hour observation. Two days later he is back in the hospital, this time he went to the V.A., he is back ICU, the difference is, they will are not about to let him go till he is on his feet.
I guess this shows that the private for profit system does have "death panels",when is comes to costs, were the V.A. takes care of the former warrior. For those that think that private for profit health care companies will take care of you better than a govt. run system is better, you may want to spend more time thinking about it.
I am looking forward this July, at our reunion, to have good healthy arguments with my friend, about govt. vs private health care and right vs pragmatic politics, thanks to the govt. run V.A. program.

Sua Sponte”

[Richard Tipton]

09:52 AM on 05/15/2012

Most American hospitals are not profit centers today. In fact a very large percentage of American hospitals are working with negative bottom lines. The reason is that the payers are not covering the actual cost of the care. Not only Medicare and Medicaid but often time the commercial payers as well. Most hospitals concentrate on costs- which in the healthcare setting is labor- and volume. If the hospital is sending anyone home early, it is generally a decision being driven by the payer, not the physician. The major payers are benchmarked against each other just like any other industry and one benchmark is admission days per 1000 covered lifes. So the payers are driven to get patients out of inpatient beds to control this benchmark, which may or may not control their costs.
Healthcare is a mess in this country and the Healthcare reform law is going to protect the consumer and take some of the insurance companys' tricks away from them.

[jimmyjack frankentoast]

11:41 AM on 05/15/2012

total bs. healthcare reform will rape the consumer and takes nothing away from insurance companies.

[littlestripes]

05:36 PM on 05/15/2012

It is very interesting. The article you are replying to has a few other linked articles that support their claims.

You provide a lot of claims with no support. Huh.

[George McAulay]

09:44 AM on 05/15/2012

Here in Australia they send you home as early as is possible due to the MRSA golden staff problems in most hospitals.