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- Apr 11, 2017
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I am a hospitalist at a community hospital. For the past few months, I have noticed that the hospital administration has begun to pressure the ER providers and other hospitalists to admit a high number of patients regardless of medical necessity.
I am assuming that they have many empty beds that need to be filled and want to maximize revenues. I would say some of these patients that I am called to admit can simply be discharged with outpatient follow up.
Conditions that I have been asked to admit for: insomnia, chronic pain management, hypothyroidism with no evidence of myxedema coma, alcohol abuse with no evidence of hepatitis, withdrawal or intoxication, atelectasis, mild volume overload, common cold, chronic venous stasis, chronic rate controlled atrial fibrillation, broken suction equipment for a trach patient, CKD with no evidence of acute worsening, migraines, need for outpatient hospice to be set up, medical clearance for psych placement, mild uncomplicated non-gallstone pancreatitis, don't have a ride home (but live too far away for a paid taxi) and homelessness. I have been also called to admit people who simply came to the ER for "medication refills".
I have discussed this with the ER medical director and he says he has to "maintain a 20% admissions rate from the ER". Sometimes when I try to admit these people, they are bewildered and upset as to why they have to spend a night or two in the hospital. When I discharge them from the ER, I have gotten complaints from administration as to why I did not admit a particular patient. Case managers have asked me to "come up with a diagnosis" to justify the admissions.
So when I admit them, their insurance companies start questioning medical necessity. The funny thing is I get calls from the case managers to perform a "doc to doc" to convince their insurance carriers to consider the admission as inpatient and not observation. Then there are truly sick patients in the ER who are waiting for a bed for hours and hours; since the beds upstairs are occupied. Also, admitted patients are at risk for developing hospital acquired infections, delirium, pressure injuries and falls.
I have worked at other hospitals and never saw such meddling by management.
Any thoughts on this?
I am assuming that they have many empty beds that need to be filled and want to maximize revenues. I would say some of these patients that I am called to admit can simply be discharged with outpatient follow up.
Conditions that I have been asked to admit for: insomnia, chronic pain management, hypothyroidism with no evidence of myxedema coma, alcohol abuse with no evidence of hepatitis, withdrawal or intoxication, atelectasis, mild volume overload, common cold, chronic venous stasis, chronic rate controlled atrial fibrillation, broken suction equipment for a trach patient, CKD with no evidence of acute worsening, migraines, need for outpatient hospice to be set up, medical clearance for psych placement, mild uncomplicated non-gallstone pancreatitis, don't have a ride home (but live too far away for a paid taxi) and homelessness. I have been also called to admit people who simply came to the ER for "medication refills".
I have discussed this with the ER medical director and he says he has to "maintain a 20% admissions rate from the ER". Sometimes when I try to admit these people, they are bewildered and upset as to why they have to spend a night or two in the hospital. When I discharge them from the ER, I have gotten complaints from administration as to why I did not admit a particular patient. Case managers have asked me to "come up with a diagnosis" to justify the admissions.
So when I admit them, their insurance companies start questioning medical necessity. The funny thing is I get calls from the case managers to perform a "doc to doc" to convince their insurance carriers to consider the admission as inpatient and not observation. Then there are truly sick patients in the ER who are waiting for a bed for hours and hours; since the beds upstairs are occupied. Also, admitted patients are at risk for developing hospital acquired infections, delirium, pressure injuries and falls.
I have worked at other hospitals and never saw such meddling by management.
Any thoughts on this?