American Discharge

Heart attack patients from the United States were 68 percent more likely to be readmitted within one month of their discharge than patients in 16 other countries.  More evidence that we have a bad healthcare system, right?  Not exactly.   The study in JAMA also showed that U.S.-based patients were more likely to have shorter hospital stays.  What does this mean?   Our goal (which is really the insurance company’s goal) of hurrying up and discharging heart attack patients as early as possible is correlated with a higher chance of them coming back again.  Talk about common sense. Doctors and patients are damned if they do and damned if they don’t, here.   They have intense pressure from the insurance companies to get the patient out of the hospital as quickly as possible (or they won’t pay for those extra days) but then are penalized for a higher readmission rate if they come back (bogus quality score stuff).   Though this is kind of an obvious study it is a good one because it indirectly shows the insanity of our healthcare system that has too many outside interests determining the care of a patient.   How about this?  How about letting the symptoms, progress, health and situation of the individual patient determine the care of the patient and screw the quality scores and insurance companies?


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “American Discharge

  1. Steve Smith, RPh
    January 4, 2012 at 8:21 pm

    I believe the trick is to encourage patients to go to the other health system across town for the “readmission”. If both systems will cooperate on this, quality scores for both systems will suck equally forcing the insurance companies to lower their high expectations.

  2. Judy
    January 4, 2012 at 9:19 am

    You get a big ‘Hell, yeah!’ from this country gal! And as you well know its not just cardiac patients….it’s all across the board. Common sense and tort reform are two missing pieces in healthcare today. More of each might help patient care improve…maybe??

  3. Elliott Rosenworcel, M.D.
    January 4, 2012 at 8:59 am

    Was there any way to be certain that the cause of the increased readmission could be attributed to the shortened stay? I have little doubt that it contributed, perhaps greatly, but the cause/affect assumption would be stronger if the effect of short hospital stays was clearly related.

    If the money taken by insurance companies from the imposition of risky quick discharges could be applied to a better and organized followup system that didn’t confer the sole responsibility for continuity on already overburdened docs and hospitals it could too reduce readmissions.

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