Many Long-Term, Acute-Care Hospital Discharges Reflect Most Lucrative Payments
A Wall Street Journal analysis finds that patients in many of the 435 long-term hospitals that specialize in treating people with serious conditions are sent home after the hospital has maximized its Medicare payments. In other news about the health care marketplace, a report about doctors' efforts to be more attentive and the reasons Giliad doesn't do more to promote its AIDS drug.
The Wall Street Journal:
Hospital Discharges Rise At Lucrative Times
Under Medicare rules, long-term acute-care hospitals like Kindred’s typically receive smaller payments for what is considered a short stay, until a patient hits a threshold. After that threshold, payment jumps to a lump sum meant to cover the full course of long-term treatment. That leaves a narrow window of maximum profitability in caring for patients at the nation’s 435 long-term hospitals, which specialize in treating people with serious conditions who require prolonged care. General hospitals are paid under different rules. A Wall Street Journal analysis found that many long-term-hospital companies discharge a disproportionate share of patients during that window when hospitals stand to make the most, a sign that financial incentives in the Medicare system may shape patient care. (Weaver, Wilde Mathews and McGinty, 2/17)
The New York Times:
Doctors Strive To Do Less Harm By Inattentive Care
Suffering. The very word made doctors uncomfortable. Medical journals avoided it, instructing authors to say that patients “ ‘have’ a disease or complications or side effects rather than ‘suffer’ or ‘suffer from’ them,” said Dr. Thomas H. Lee, the chief medical officer of Press Ganey, a company that surveys hospital patients. But now, reducing patient suffering — the kind caused not by disease but by medical care itself — has become a medical goal. The effort is driven partly by competition and partly by a realization that suffering, whether from long waits, inadequate explanations or feeling lost in the shuffle, is a real and pressing issue. (Kolata, 2/17)
Reducing Medical Overtreatment Will Require Large-Scale Medical Mobilization
Despite all the reports about overdiagnosis and overtreatment in the United States (and estimates are that almost a third of all medical interventions in this country are unnecessary), many doctors want to take a more reasoned and less wasteful approach to medicine. But those “lone ranger” doctors are up against a powerful medical industrial complex that “just keeps on delivering treatments patients don’t need,” as journalist Shannon Brownlee (“Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer”), now senior vice president of the Lown Institute, explains in a recent article for the website KevinMD. (Perry, 1/17)
Gilead's Pill Can Stop HIV. So Why Does Almost No One Take It?
Gilead Sciences Inc. may be one of the first drugmakers in history to have people asking why it’s not doing more to pitch its medicine. Truvada, Gilead’s HIV drug, has been approved since 2004 for people with the virus. In 2012, use was expanded to people without HIV as a way of preventing transmission -- a practice called PrEP, or pre-exposure prophylaxis. Taken daily, it can prevent infections 92 percent of the time, meaning it could drastically reduce new infections in sexually active gay men, among the U.S.’s highest-risk communities. (Chen, 2/18)