Posted by Bill Sandweg on 18 February 2015.
Some hospitals are making treatment decisions on the basis of the money they will make as opposed to what is in the best interests of the patient. This is especially problematic as hospitals continue to buy doctor practice groups and gain the power to direct doctor decision making. Making a medical decision on the basis of how much money a hospital will make or lose as opposed to what is in the best interest of the patient is the definition of hospital malpractice and unethical behavior.
The Wall Street Journal continues to explore the payment data it obtained by lawsuit from the Centers for Medicare and Medicaid Services. In its most recent article, it discusses how long-term acute care hospitals time the discharge of their patients to maximize the amount of money they receive from Medicare. Medicare has given each illness which might cause long hospitalization a specific code. For each illness code, Medicare has established a time range for the average patient stay. It pays a certain amount until the patient reaches the mid-point of the range at which time Medicare ups its payment significantly. The payments then drop for the rest of the average stay so that the hospitals actually lose money if the patient stays much beyond the mid-point. In other words, these hospitals collect the maximum amount when a patient is discharged just after the mid-point. Guess what the Journal found? Surprise! Across all illness codes, these hospitals were discharging a disproportionate number of their patients just after qualifying for the maximum Medicare payment.
Former hospital administrators interviewed by the Journal reported that their corporate bosses pressured them to maximize earnings by getting patients out the door just after the maximum payment date. Bonuses were based in part on discharging patients at the most profitable moment and keeping earnings high. So what does this mean for you? It means that if you are a long-term Medicare patient at one of these hospitals, you may be kept in longer than you need to be so that the hospital can milk your stay for the highest payout. Of course, every day in the hospital is a day when you are exposed to more infections, more risk of medical mistake, and more costly and perhaps unnecessary care. On the other side, once you hit the maximum pay date for the hospital, you may be discharged even though you are not ready to be sent home.
This is another article in an excellent series by the Wall Street Journal. We have commented on other articles in the series here, here, and here. Each of the articles provides further proof for something we have been saying for years: Medicine is a business and you are its customers. Some doctors and hospitals are making treatment decisions based on money and not patient need. Don’t accept everything you are told at face value. When a doctor or hospital tells you that you need some test or procedure, remember that they make money when you agree and do not make money if you do not agree. Be an informed consumer of medical services. You may save money. You may save your health and you may not have to come visit me to see if you have a medical malpractice case.