Hospitals Medicaid/Medicare Physician Compensation

To Curb Repeat Hospital Stays, Pay Doctors

Much of my own research has focused on how physician financial incentives affect the quantity and quality of medical care. It should come as no surprise that I found a recent New York Times article on the topic stimulating.  Dr. Sandjeep Jauhar examines how hospital and physician financial incentives affect the length of a patient’s hospital stay.  An excerpt is below.

My hospital, like all acute-care facilities, receives a set payment per admission based on the patient’s diagnosis. So the longer a patient stays in the hospital, the more money the hospital stands to lose. Of course, the longer a patient stays, the greater the likelihood of hospital-acquired infections or harm from tests and procedures, which means timely discharge in most cases is good for hospitals and patients alike.

But doctors, paid separately by Medicare, have little motivation to discharge patients quickly. As long as their patients are in the hospital, they can bill and be paid for each visit they make.

I discussed this issue with an internist in private practice, who requested anonymity because of the sensitive nature of the subject. His patients, it seemed to me, were often staying longer in my hospital than necessary. “I understand why hospitals want to cut down length-of-stay,” he told me matter-of-factly. “But if I discharge a patient early, I don’t get paid. It’s O.K. if you have enough patients in the hospital, but if you don’t, you sometimes have to drag out the stay. I don’t like to do it, but sometimes you have to.”

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