Study: Hospital Discharge of Medicare Beneficiaries Increased Utilization Rates and Spending Post Discharge

An observational trial published in the latest issue of Annals shows that the initial savings to overall healthcare costs incurred by acute hospitals with hospitalist (hospital-based physician) care are offset by increased costs to Medicare in spite of the earlier discharges of beneficiaries (0.5 day on average shorter than those patients without hospitalist care).

Most of the extra costs stemmed from re-admissions and patients being sent to nursing homes instead of home. But there’s no clear explanation for the findings.
“Under pressure to shorten length of stay, hospitalists may be willing to discharge sicker patients, leading to increased re-admissions,” Dr. Lena Chen and Dr. Sanjay Saint of Ann Arbor Veterans Affairs Medical Center wrote in an editorial, according to Reuters, which was first to report the study.But they added that unmeasured differences could also play a big factor.

Besides the fact that this study is observational in nature, and therefore immediately affected by selection bias, it does shed light on areas to be studied further — including disease-based criteria for discharges based upon DRGs, the effect of preventive medicine on readmission rates in Medicare patients, and the impact of undocumented acute care complications at discharge (eg, medical errors). The proverbial tip of the iceberg is at play here. Still and interesting read, though. | PDF LINK