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Treat 'em and Street 'em

September 1st, 2006

by Nick Jacobs

What's happening in U.S. hospitals?

HFO, hold for observation is a term that strikes fear into the heart of any good hospital chief financial officer. Simply put, it's an insurance company phrase that means "do everything that you can for the patient." We (the insurance company) will wait for up to three days to see if anything is really going on with the medical diagnosis, you (the hospital) can threat the patient exactly the same as any other inpatient, and we (the insurance company) will pay you only for the outpatient tests."

Last year, clearly 50% of our inpatient census fell into this HFO status. This decision support tool for the insurance company literally strips millions of dollars from the bottom line of the hospital, and the insurance company can reward their stock holders or stake holders accordingly.

Another trend that seems to be growing exponentially is the emergency departments' philosophy of "treat em and street em." Get the patient in, stabilize them, treat them, and send them back out the door. Once again, at our facility, a 40% increase in Emergency Department visits and a decline in overall admissions to the hospital?

Finally, in the last ten years, the newer drugs have resulted in significant improvements to overall patient health and stability which has also contributed to, not unlike what has occurred in pediatrics, less admissions to the hospital.

If any of you are still following this line of thought, it means that primary acute care hospitals could see less and less inpatients on a daily basis. Is this good or bad?

Probably this same blog could have been about fossil fuels and the decline in the use of gasoline engines. To which your response might also be, good.

Consequently, the topic should really be "Who Moved My Cheese?" The cheese is moving. Maybe not in all of our hospitals, but it's moving, and we, collectively need to understand that the paradigm is shifting, the flow is being altered, and the current system, not unlike the Industrial Era, is coming to an end.

So, move on to the new model. or better still, help INVENT IT.

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