[Warren Kiefer]

Originally Posted by Nightengale212

As an R.N. case manager who has a small role with discharge planning, often times delays have to do with awaiting lab or other test results. The doses of medications that a patient will be discharged on are often determined by lab results for example the anticoagulant medication Coumadin is determined by the PT/INR result. Also getting x-ray and CT scan readings on day of discharge can cause major delays. Most hospitals now electronically transmit x-rays to radiologists all over the world and have to wait for a radiologist in Australia for example to read the films and transmit back the results. Some attending physicians will write discharge orders in advance but will include pending a particular lab or test result which requires the discharging physician/hospitalist to review the results and make any necessary order changes.

Believe me, the hospital staff dislikes these discharge delays as much as the patient because more often than not there is a patient in the ED who is in very much in need of that bed.

Sorry, but the doctors I and my friend were not an attending physicians. I had no tests and my only prescription was already written by my primary doctor. And it was true that my nurse was not a part of the delay. I do understand your reasoning and and appreciate your comments.

[BnCinME]

I would be interested in what the hospitalist charges for his discharge duties. Check your bills. If you didn't see the hospitalist I would question the charge. It sounds like they need more than one hospitalist on duty each day. Especially during high season. Covering two campuses sounds ridiculous. Just think about all those poor souls waiting in the ER for a bed....

[Doro22]

Hehe! When we lived about 2 miles from the hospital down in Hollywood my hubby was in there once for chest pains, which turned out to be nothing thank goodness. So I was at work when he was released. He walked home in his hospital robe. Geez! I was amazed that he wasn't picked up by the mental health people. We still have that robe.

[Sable99]

It has happened twice with my Mom -- here in Michigan.

About a year and a half ago, Mom (89 at the time) was told she could go home at 1 in the afternoon. After several hours, we asked the RN what the delay was. She said the hospitalist was busy and we had saw him walking down the hall many times during the day. The hospitalist apologized profusely and told us there was a miscommunication! Mom was discharged at 11:50 PM -- that's right, 10 minutes to midnight! The next day the hospital called about her hospital stay and she told them what time she was released! She never received a bill for that hospital stay and she was in ICU 4 days!

In December, Mom was released six hours after she was told she could go home. We were told the hospitalist would see all the patients on his rounds and then sign the paperwork. We found out later that he was discharging a lot of patients because it was New Year's Eve. We wondered if he wanted to discharge them before the new calendar year for insurance purposes.

[Nightengale212]

Originally Posted by Warren Kiefer

Sorry, but the doctors I and my friend were not an attending physicians. I had no tests and my only prescription was already written by my primary doctor. And It was true that my nurse was not a part of the delay. I do understand your reasoning and and appreciate your comments.

I hope your friend eventually made it home safe and sound. As difficult as discharge delays are for patients, believe me it is the lesser of two evils with the greater evil being discharged too soon. On more than one occasion I have had patients show up in the clinic that were discharged from the hospital a few days prior asking me to take out the IV that was still in their arm!!!

[GeoGeo]

Is this Hospitalist doctor position something fairly new, just down here, or have they always existed. Never heard of it before being down here.

[dbussone]

Originally Posted by GeoGeo

Is this Hospitalist doctor position something fairly new, just down here, or have they always existed. Never heard of it before being down here.

They are all over the country, and have been for 10+ years. Some are employees of insurance companies, some are independent contractors, some are hospital employees.

[Dr Winston O Boogie jr]

Originally Posted by spring_chicken

Just out of curiosity, is there a problem with getting up and leaving when the first doctor tells you that you can go home? I know you would be leaving against medical advice... but technically, you're not.
I did it one time years ago in another state. Have things changed and they have some way to keep you from leaving?

I did that once. I told them I was leaving and they said that I would be leaving against medical advice. I was then told that I had to sign some papers absolving them of responsibility.

I told them that I'm not signing anything and walked out. A nurse tried to stop me and I asked if she'd like to be reported for kidnapping. She got out of my way and I left. Never heard from them again.

[Warren Kiefer]

Originally Posted by Nightengale212

I hope your friend eventually made it home safe and sound. As difficult as discharge delays are for patients, believe me it is the lesser of two evils with the greater evil being discharged too soon. On more than one occasion I have had patients show up in the clinic that were discharged from the hospital a few days prior asking me to take out the IV that was still in their arm!!!

He finally did make it home, a bit stressed out but home at last. My original point was to the effect that your primary doctor, the one that was in charge of your care, released you to go home. You now find that a doctor whom you have never seen or was never involved in your care must sign your release papers. What is the purpose of this "hospital doctor" and why is he now in charge of you going home. I would risk a fortune betting that the so called hospital doctor has never reversed the decision of a person's primary doctor. And again. thanks for asking about my friend.

[sunnyatlast]

The new ACA-related penalty reductions in Medicare/Medicaid/Insurance payments to hospitals, due to re-admission of the patient within 30 days is probably part of why they have to do more CYA when releasing a patient.

If they have to come back due to relapse or complication within the 30 days, payments are cut to thousands of hospitals already losing money on Medicare payments that are less than the cost of providing the services, and private insurers pay what Medicare pays:

…..Under the new fines, three-quarters of hospitals that are subject to the Hospital Readmissions Reduction Program are being penalized. That means that from Oct. 1 through next Sept. 30, they will receive lower payments for every Medicare patient stay — not just for those patients who are readmitted. Over the course of the year, the fines will total about $428 million, Medicare estimates.

...The fines are based on readmissions from July 2010 through June 2013.

In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties.

Medicare Fines 2,610 Hospitals In Third Round Of Readmission Penalties | Kaiser Health News

Then read how these and other penalties are 4 times greater than the Quality Bonuses most hospitals are earning, with the new rules for that:

Medicare is giving bonuses to a majority of hospitals that it graded on quality, but many of those rewards will be wiped out by penalties the government has issued for other shortcomings, federal data show.

As required by the 2010 health law, the government is taking performance into account when paying hospitals, one of the biggest changes in Medicare’s 50-year-history. This year 1,700 hospitals – 55 percent of those graded – earned higher payments for providing comparatively good care in the federal government’s most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, led to penalties for 1,360 hospitals.

However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That’s because the others are being penalized through two other Medicare quality programs: one punishes hospitals for having too many patients readmitted for follow-up care and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways….

1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect | Kaiser Health News

Maybe some of this will be instructive as to why doctors and nurses doing actual patient care and interaction is far down the list of priorities amongst all the things they have to do.

They're bound, gagged and handcuffed to a computer screen by the growing bureaucracy and the patient comes last!

[dbussone]

Sunny - I agree with much of what you say. But, most hospitals are not losing money taking care of Medicare patients. Medicaid, yes; but not Medicare unless they are poorly run.

[sunnyatlast]

Originally Posted by dbussone

Sunny - I agree with much of what you say. But, most hospitals are not losing money taking care of Medicare patients. Medicaid, yes; but not Medicare unless they are poorly run.

Ok. Is this incorrect, quoted above in red?

"In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties."

Also: In your hospital administration experience, are the added government-mandated rules conducive to patient care and wellness, or a hindrance?

[DonH57]

I try my best to stay out of hospitals. I have too say though that sometimes it takes some working to get out of county in a timely fashion.

[dbussone]

Originally Posted by sunnyatlast

Ok. Is this incorrect, quoted above in red?

"In New Jersey, every hospital but one will lose money this year. So will a majority of hospitals in 28 other states, including California, Florida, Georgia, Illinois, Massachusetts, New York, Ohio, Pennsylvania, Tennessee and Texas, as well as the District of Columbia, according to a Kaiser Health News analysis of the penalties."

Also: In your hospital administration experience, are the added government-mandated rules conducive to patient care and wellness, or a hindrance?

Well let's take a look at Florida. There are at least 4 major for-profit chains in FL: UHS, HCA, CHS, and TENET. do you think they would be operating here if they could not make money on Medicare patients?! Each of their stock prices has risen considerably over the last 3 years.

As for the additional mandates, I believe they are a hindrance to an appropriate physician patient relationship and represent too much government intrusion into that relationship. They are also, in many cases, unrelated to patient care. IMHO

[dbussone]

UHS 3 year price chart:
http://www.marketwatch.com/kaavio.We...579&mocktick=1