Daniel J. Brotman, MD; Romsai T. Boonyasai, MD; Amy Deutschendorf, MD
Potential Conflicts of Interest: None disclosed.
Brotman DJ, Boonyasai RT, Deutschendorf A. Hospital Care and Medical Utilization After Discharge. Ann Intern Med. 2011;155:720-721. doi: 10.7326/0003-4819-155-10-201111150-00019
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Published: Ann Intern Med. 2011;155(10):720-721.
TO THE EDITOR:
Kuo and Goodwin (1) provide evidence that hospitalists must improve how they transition patients back to their PCPs and that suboptimal transitions of care may cause excess postdischarge costs. However, we are intrigued that the per-day charges for hospital care varied so dramatically between hospitalized patients cared for by hospitalists versus those cared for by PCPs.
By analyzing length of stay (LOS) and total charges from Medicare Provider Analysis and Review files, the authors found that the mean LOS among patients cared for by hospitalists was 5.17 days with mean charges to Medicare of $15 019 per admission, whereas the mean LOS among patients cared for by PCPs was 5.82 days with mean charges to Medicare of $15 301. If these estimates are precise, then mean hospital charges were less than 2% lower for patients cared for by hospitalists despite a reduction in LOS of more than 11%. These data translate into hospital charges of $2629 per day for care by a PCP and $2905 per day for care by a hospitalist—a difference of almost 10%. This finding contrasts sharply with other published data suggesting that LOS reductions closely parallel cost reductions (2-3).
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