Doctor’s Diary November 2, 2017: Older and sicker stay shorter

(Snippets from the frontline)

Older and sicker stay shorter

When an elder senior is admitted to a hospital, Medicare pays a flat fee based on diagnosis to cover the length of stay.  Needless to say, the faster they discharge the patient, the less it costs the hospital.

For those younger and under 65 with regular insurance, they stay longer than Medicare patients.  Why?  Because the hospital gets higher daily insurance reimbursement enhancing profits without a flat fee.

Concurrently, hospitals hire an army of personnel to bombard admitting doctors to decrease Medicare senior length of stay, but rarely those patients with private insurance.

So, if you are older and sicker, you stay shorter.  If you are younger with private insurance, you stay longer and get more care. 

This defies healthcare logic but is a financial windfall to the bottom line of hospitals.

For elder seniors, the bottom line is a negative effect on longevity.

Gene Uzawa Dorio, M.D.


  • Gene says:

    Beyond your job and up the ladder are those in administration that continually pummel physicians to move Medicare patients out of the hospital even though they are still ill. The criteria for continued admission is skewed for hospital profit, and many times does not reflect the true illness of the patient.

    That is where clinical training and experience of the primary care physician is valued recognizing the true status of the patient. They are at bedside examining and talking to the patient and family. “Army” members look only at computers numbers, don’t exam the patient nor discuss medical questions, and therefore lack the full clinical picture.

    Criteria hospitals use is certainly necessary, but is sometimes faulty…very faulty.

    I’m sure all patients are “looked at” relative to their insurance issues, but doctors are targeted by administration concerning length of stay of Medicare patients, and not private insurance. Hospital data bears this out.

    Gene Uzawa Dorio, M.D.

  • Susan Salkeld says:

    As one of the so called army of hospital personnel who watch the medicare patients ,we also watch the insurance patients very closely as well because their stays are denied when they lack criteria. The insurance patients are looked at everyday and reviews are sent to insurance companies who will decide whether or not the patient continues to have acute care criteria for continued inpatient hospitalization and if not they will stop paying. The medicare patients are not reviewed like this as Medicare does not require daily reviews. All patients are reviewed to the same criteria regardless of age or insurance coverage or lack of insurance coverage. I respectfully disagree with Dr Dorio’s statement and all patient should have continued stay criteria to stay in the hospital and not just because they are older. A hospital is a place to take care of acutely ill patients and patient who require less care should be downgraded to the next lower level of care to continue with care as needed.

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