Jean-Sebastien Rachoin, MD
Potential Conflicts of Interest: None disclosed.
Rachoin J. Hospital Care and Medical Utilization After Discharge. Ann Intern Med. 2011;155:720. doi: 10.7326/0003-4819-155-10-201111150-00018
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Published: Ann Intern Med. 2011;155(10):720.
TO THE EDITOR:
Kuo and Goodwin (1) conducted an interesting study describing outcomes in patients cared for by hospitalists or by PCPs. Certain points in the complex equation that is the U.S. health care system need to be mentioned.
The higher rate of readmissions or higher cost for patients cared for by a hospitalist could be substantially influenced by the underlying characteristics of this patient population, including more comorbid conditions and more admissions from nursing homes than other patients. The current bed-hold policy by Medicaid allows skilled nursing facilities and nursing homes to continue to receive patients' Medicaid payments for 7 to 10 days even if patients are hospitalized. Such a policy has already been shown to be associated with higher rates of hospital readmissions (2). Furthermore, because the authors mention the “incentive” for hospitalists to shift costs, it would also be fair to note the “absence of incentive” for nursing homes to reduce readmissions and that it is “easier” for facilities to readmit patients to hospitals when they develop questionable symptoms (especially during weekends or at night) (3).
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