Study: Post-Discharge Costs Negate HM's In-Hospital Savings


A new report that suggests the lower costs and reduced length of stay (LOS) associated with hospitalist care of hospitalized Medicare beneficiaries is offset by higher costs post-discharge highlights progress and opportunities for hospitalists, SHM's president says.

The federally-funded study published Monday in Annals of Internal Medicine showed that while hospitalists clearly reduced LOS and cut in-hospital spending (by $282 per hospital visit), Medicare costs in the 30 days post-discharge were $332 higher than those followed up by primary care physicians. Patients discharged by hospitalists were less likely to be sent straight home and more likely to be admitted to a nursing home.

SHM President Joseph Li, MD, SFHM, associate professor of medicine at Harvard Medical School and director of the hospital medicine division at Beth Israel Deaconess Medical Center in Boston, says the data underscores the need for programs like SHM's Project BOOST, which helps hospitals improve discharge and reduce readmissions.

Dr. Li notes two limitations to the research. First, the patients reviewed were all from 2001-2006, long before the current healthcare debate surrounding cost containment and patient safety. Second, the review does not account for the quality of medical care.

“The study was done at a time which was early in the hospitalist movement,” Dr. Li says. “It’s fair to say at that point we weren’t talking as a field as much about trying to prevent unnecessary readmissions. ... When I look at this study, I think it’s an opportunity for hospitalists to think how we can improve on communications with post-discharge facilities. How we can improve transitions.”

An accompanying editorial agreed, noting that while hospitalists and outpatient care might be viewed in different silos, “patients regularly move back and forth across that divide.”

“It is important to better understand the association between hospitalist care and costs,” editorial co-author Lena Chen, MD, MS, Division of General Medicine, University of Michigan, writes in an email to The Hospitalist. “This paper takes a big step towards addressing this subject with a large study, and will hopefully spur additional related research. That would be a good thing for hospital medicine.”

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