Hospitals trying to extend your stay?

[dennis in se pa]

Anyone experience a hospital trying to extend their stay? I have several times had an experience where an in hospital Doc wanted to check me in for an outpatient procedure the next day. MRI, colonoscopy procedures. They made me sign an Against Medical Advice form in order to leave. I guess they are under pressure to keep the beds full. Also felt a time or two that my time in the hospital was artificially lengthened for the same purpose.

[Scott Douglas]

Last time I was in a hospital I was surprised when they booted me out. In at 6AM with a gall bladder attack, out by 3PM after an arthroscopic removal of said bladder.

[dennis in se pa]

If you have good insurance this is more probable. Some insurances do what they can to shorten your stay - yes Medicare w advantage plans are lucrative.

[dennis in se pa]

Originally Posted by Scott Douglas

Last time I was in a hospital I was surprised when they booted me out. In at 6AM with a gall bladder attack, out by 3PM after an arthroscopic removal of said bladder.

Well what was the end result?

[pavulon]

Originally Posted by dennis in se pa

Anyone experience a hospital trying to extend their stay? I have several times had an experience where an in hospital Doc wanted to check me in for an outpatient procedure the next day. MRI, colonoscopy procedures. They made me sign an Against Medical Advice form in order to leave. I guess they are under pressure to keep the beds full. Also felt a time or two that my time in the hospital was artificially lengthened for the same purpose.

The real $$ penalty is in (deemed) avoidable re-admissions.

[pwd72s]

Originally Posted by dennis in se pa

Well what was the end result?

He died..

[URY914]

Hospitals don't make money by keeping you in as a patient. They want to get you out and the next patient in asap. They make money on billable procedures. I work at one.

[Scott Douglas]

Originally Posted by dennis in se pa

Well what was the end result?

Uh, everything went OK. Took four days off from work. I don't digest 'fat' as well now, but that doesn't keep me from eating the things I shouldn't.

[Cajundaddy]

As we get older, hospitals look to us as a cash cow. Medicare patients are a sure thing so they want to keep you and run lots of tests. Filling the schedule with MRI, CT, angiogram tests pays for the machines and fattens the bottom line. It's the equivalent of "would you like to supersize it" but with an added penalty that if you say no you have to sign out AMA to avoid a bunch of expensive and often unnecessary testing.

I am a pretty big advocate of modern diagnostic testing when you have clear symptoms of disease but if they want to go on a fishing expedition... no thanks.

[mepstein]

Originally Posted by Cajundaddy

As we get older, hospitals look to us as a cash cow. Medicare patients are a sure thing so they want to keep you and run lots of tests. Filling the schedule with MRI, CT, angiogram tests pays for the machines and fattens the bottom line. It's the equivalent of "would you like to supersize it" but with an added penalty that if you say no you have to sign out AMA to avoid a bunch of expensive and often unnecessary testing.

I am a pretty big advocate of modern diagnostic testing when you have clear symptoms of disease but if they want to go on a fishing expedition... no thanks.

That's not really how it works. Many problems don't have clear symptoms but can piggy back on other issues. Hospitals don't order the tests, doctors and NP's do. They are trying to make sure they get a complete reading about your health. If they don't do the (standard) tests and miss something, it doesn't help anyone. You don't have to agree to the tests but at least ask why they are being ordered. It's not like the dr or nurse gets a cut.

The hospitals don't encourage the dr's and nurses to keep the beds full, it's actually just the opposite.

[pavulon]

Originally Posted by mepstein

You don't have to agree to the tests but at least ask why they are being ordered. It's not like the dr or nurse gets a cut.

The exception to the above is private clinics.

Locally, the private ortho group built a big new clinic inclusive of a surgery center in their home town about an hour away. Of course, they started steering patients to that clinic for MRIs telling patients that the MRI in a truck that came to town (hospital) 3 days/week produced inferior images. The hospital invested several million $ to build an in-house, state-of-the-science MRI suite. So guess what is running in the clinic parking lot 3 days per week now. Yup. The same MRI truck.

[wdfifteen]

It's just CYA. The insurance company wants you out of there as soon as you can breath on your own. The doc wants you to get well and not get sued. The hospital just wants to not get sued.

[Gogar]

My buddy just went in last Friday with an aneyrism. They stabilized him and scheduled surgery for Monday. Aneyrism ruptured on Saturday. Took him off the machines this morning.

Is that what you mean?

[stevej37]

The opposite here.
Two years ago I was hit by a car while biking. My femur x-rays looked like a broken chicken leg with shards sticking out from both broken ends.
The doc did an intermedullary nailing which involved drilling the femur lengthwise and then hammering in a titanium rod. The rod was then screwed to the bone.
I was out of surgery at 2PM and they discharged me at 5PM of the same day.

Looking back..there really was no reason to stay in the hospital. A person can rest-up and recover at home a lot easier.

[KFC911]

^^^^ That really sux. Condolences to those around him....

[Brando]

My experience has varied. When I had appendicitis in 2007 the hospital insisted I stay at least 4 days post-op so I did. My insurance was marginal.

Second instance where I was hospitalized was after a motorcycle accident. The hospital rushed to get me on crutches and out the next afternoon.

[RonDent]

I had the opposite experience. Last year I was in a car accident. Broke a few things, 2 ribs, sternum, 2 vertebrae..etc...after 1 day they asked if I was ready to go home. I hurt so bad I asked to stay another day.

[Noah930]

Really sorry to hear that, Jeremy.

To the OP, in general hospitals try to get rid of patients as quickly as possible, so I'm not sure the situation is as you think it is. It's all about Length of Stay. Kind of like mechanics and book rate. Insurances pay a set fee for a diagnosis (or procedure for that diagnosis). If a patient stays shorter than the LOS, the hospital makes a little more money. If the patient stays longer than the LOS, the hospital loses money. So the push (from administration) is to get people out as quickly as possible. For certain procedures that are expected to be of the outpatient variety (like MRIs or colonoscopies), the hospital doesn't make any money on that admission, unless there is a complication that necessitates the hospital stay (i.e. uncontrolled pain, nausea, allergic reaction).

edit: One area where I have seen hospitals try to keep patients for longer than "normal" concerns reimbursement for implanted hardware. For surgeries that are deemed minor enough to not require hospitalization (for day-surgery procedures), the implanted hardware is not reimbursed by insurance. Plates and screws and artificial joints may easily cost a few thousand dollars. That gets "eaten" by the hospital (or surgery center). The insurance reimbursement for the facility may not be enough to cover the cost of the hardware. So for same-day surgeries, the facility eats the cost of the hardware. Those surgeries may actually be money losers for the facility. However, if a patient stays overnight, then insurance reimburses the facility for the implanted hardware. So I have seen instances where patients were scheduled for day surgery, but then admitted for "pain control" afterwards so that the hospital could get the implanted hardware reimbursed by insurance. Which is somewhat retarded, because now the insurance company has to pay for the hardware as well as a night in the hospital.

[Cajundaddy]

Originally Posted by mepstein

That's not really how it works. Many problems don't have clear symptoms but can piggy back on other issues. Hospitals don't order the tests, doctors and NP's do. They are trying to make sure they get a complete reading about your health. If they don't do the (standard) tests and miss something, it doesn't help anyone. You don't have to agree to the tests but at least ask why they are being ordered. It's not like the dr or nurse gets a cut.

The hospitals don't encourage the dr's and nurses to keep the beds full, it's actually just the opposite.

I will politely disagree. Mrs. Cajun is head of Radiology at a major Med Center and has seen this stuff with senior patients for 30 years and at 3 different hospitals. Fear of malpractice suits seems to be a major driver to over-treat and over-diagnose patients by MDs, especially in the 65+ age group. This practice is fully endorsed by the hospital bean counters, and as a result, over-treatment is rampant in the US.

Minimizing Fear-Driven Diagnostic Testing

We went through a similar experience to the OP last week. Aunt Paula is 86, can barely walk and has dementia. She was admitted to ER due to a fall but "while they are in there" the PA ordered a battery of CP testing due to a possible narrowing of her arteries. My wife talked directly to the PA and got the full court press on diagnostic testing. She asked "what are you going to do if you find narrowing, surgery? She is 85, can barely walk, and has significant dementia. You can't fix that with surgery. AMA release papers please."

She was pissed.

[dennis in se pa]

More nights and more blood tests = more charges around here.