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Editorials |

Moments in Time

Lena M. Chen, MD, MS; and Sanjay Saint, MD, MPH
[+] Article, Author, and Disclosure Information

From Hospital Outcomes Program of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI 48109.

Acknowledgment: The authors thank Drs. Scott Flanders, Joel Howell, and Larry McMahon for reviewing an earlier version of this manuscript.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1404.

Requests for Single Reprints: Lena M. Chen, MD, MS, Division of General Medicine, University of Michigan, 300 North Ingalls, Room 7E02, Ann Arbor, MI 48109-0429; e-mail, lenac@umich.edu.

Current Author Addresses: Dr. Chen: Division of General Medicine, University of Michigan, 300 North Ingalls Street, Room 7E02, Ann Arbor, MI 48109-0429.

Dr. Saint: Division of General Medicine, University of Michigan, 300 North Ingalls Street, Room 7D21, Box 5429, Ann Arbor, MI 48109-5429.

Ann Intern Med. 2011;155(3):194-195. doi:10.7326/0003-4819-155-3-201108020-00010
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In this issue, Kuo and Goodwin present data suggesting that savings during a hospital stay that are associated with hospitalist care may be offset by higher expenses after discharge. The editorialists discuss the cautions that are needed in interpreting these findings and speculate on why hospitalist care would be associated with greater use of postdischarge services.

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Hospitalists and quality
Posted on August 26, 2011
Charles L Carter
Methodist Hospitals
Conflict of Interest: None Declared
The comments by Dr.s Chen and Saint, as well as the original article by Kuo and Goodwin, are both informative and dismaying. After 17 years in primary care, I became a private practice hospitalist in 2005. I neither contract with any hospital nor am I a hospital employee. Despite their assertion, I feel no greater pressure to shorten length of stay now than I did when practicing primary care. Naturally I would expect this to be quite different whenever a physician has a direct financial reliance on their institution. Additionally, I question their logic when stating the "study included medical hospitalizations from 2001 to 2006, before 30-day readmissions were widely used as a benchmark of quality for hospitals ". I believe readmission rates do reflect one aspect of quality of care, regardless of their status as a benchmark; though I am not convinced measurement of said benchmarks is particularly effective (see "The Wire", episode 28). Lastly, the payment formulas in place provide VERY strong incentive to provide either office care or hospital care, but not both. Like so many other areas of our jumbled, pieced together "system", altering financial incentives could readily lead to more appsopriate, better and less expensive care ( and ACO's ain't in it).

Conflict of Interest:

None declared

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