The Crimson Squeeze by Stella Fitzgibbons MD
The Advisory Board Company offers a software package that offers hospitals everything they need to decide which physicians are turning in the kind of “performance” the hospital needs…not for patient care, mind you, but for the hospital’s bottom line. A program named Crimson plugs neatly into the hospital’s electronic health record and produces a “dashboard” for admitting physicians. This program–already implemented in dozens of hospital systems across the country–lets administrators see how a doctor’s length of stay and price per encounter compares with that of colleagues in the same specialty. Of course, if you’re trying to handle hospital and office care at the same time, or if you take ER call and therefore admit more uninsured patients with problems that will never be addressed in the outpatient setting, your numbers will be worse. Maybe bad enough to win you a free visit with the chief of your specialty or the hospital’s chief financial officer.
Hospital doctors already face a steady stream of sticky notes and phone calls (none of which ever appear in the final record, so you can’t use hospital-based pressure as a justification for premature discharge) reminding us to document every last zit and abnormal lab test; the ICD systems also allow an estimated length of stay to be predicted the minute we list a patient’s admitting diagnoses, and God help us if we don’t have the patient out of the room by 11 a.m. on the predicted date of discharge. With hospitals facing penalties for early readmissions, you can bet that your name will go on a list every time a pneumonia or CHF patient returns in less than 31 days.
I know hospitals are under pressure–hey, I practice in one of the states that refused to expand Medicaid. But doctors can only be squeezed so hard before they start to realize that maybe hospital privileges aren’t such a privilege.
Ask me if I believe it is coincidence that when my 95 year old father was “admitted for observation” before he moved into long term care, that he was “released” to a rehab unit where he spent weeks, only to later find out that officially, his in patient stay did not exceed the magic 3 days to kick in his insurance. Cost him thousands, and everyone is sorry, and say if they had listed 3 days, it would have been medicare fraud. Is it not possible that the opposite is not true, on a daily basis? That all of these 2+ day stays are also fraud, just for the sake of $$. No one wanted to answer that one for me, but I felt much better that they said they were sorry, but there was nothing they could do. NOT!
well said
Good article Stella, especially the graphic. This crap is really accelerating.