Hospitals base discharges on payments, not patient progress

Many providers discharge Medicare patients based on when it is most lucrative to do so rather than improved patient condition, the Wall Street Journal reports.

For example, a Kindred Healthcare Inc. hospital in Houston discharged Ronald Beard to a nursing home after treating him for knee surgery complications for 23 days, which netted the hospital nearly $36,000 from Medicare, the most it could receive for treating his condition. Discharging Beard only a day earlier would have meant a payment of more than $15,000 less, according to the article, and a longer stay would likely have meant the hospital received no additional money from Medicare.

Medicare offers long-term care facilities such as the Kindred hospital smaller payments for shorter stays, and pays them a lump sum meant to pay for long-term treatment once they reach a threshold, according to the newspaper. The WSJ analysis of Medicare claims paid from 2008 through 2013 found many such facilities disproportionately discharge patients during the window allowing them to receive the maximum payment.

Between 2008 and 2013, long-term hospitals discharged a quarter of patients within three days of reaching the length-of-stay minimum, five times as many as were released in the preceding three days, the analysis found. From mid-2011 to the end of 2013, the Kindred facility discharged eight times as many patients on the day they reached the threshold as on the last day before it, and discharge rates fell drastically after the three-day maximum-payment window.

"The healthcare system should serve the patients and try to improve their health, and any step away from that is a corruption," Tom Finucane, M.D., of Johns Hopkins University School of Medicine, told the WSJ, calling the findings "troubling and disturbing."

Research in 2013 found the discharge process for older patients is often confusing, with little more than half of patients able to accurately describe their own diagnoses. An American Hospital Association case study also found several aspects of discharge planning hospitals should incorporate, including physician involvement and prioritizing health during the patients' stay, FierceHealthcare previously reported.

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