Physicians in a small urban hospital are reluctant to discharge older

QUESTION

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care.

The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators?

a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.
b. Local home care services are expressing concern about the increased acuity of patients being discharged into their care.
c. The resource-based relative scale for physicians does not account for the increased length of stay.
d. Acute care patients are being denied entry to the hospital because of the increased stay of patients.

ANSWER:

ANS: A
Length of stay (LOS) is the most important predictor of healthcare costs and extra days are a cost to the organization in terms of both the extra days and decreased patient volume. The situation, as outlined, does not indicate that there is a bed shortage and therefore, there is no evidence that other patients are being denied access to services or that additional patient volume is not being captured. The hospital would be concerned about the impact on its income because of the additional, uncompensated care costs incurred for patients who exceed the usual length of stay explicitly calculated under PPS and the DRGs.