Re: Inpatient Admission and LOS

[Guest guest]

Since the VA docs salaries aren't affected by their practice patterns, and

since this is the way docs have been reimbursed in the VA system over time,

then it make sense to me that prevailing community standards will play a

larger role since their system isn't undergoing the upheaval that is

occurring in the private sector. While the VA docs fixed salaries could be

loosely compared to the fixed payments of capitation, I assume they don't

have to worry about withholds and the like nor do they have to worry about

the possibility of being booted out of a plan due to being outside of the

plan's utilization or cost targets. Since they aren't undergoing any change

to how they are paid, while private sector docs are undergoing big changes,

I would expect private sector doc practice patterns to reflect the changes

in their reimbursement (after all, if you pay the car dealer less money, you

get less car).

But who cares about VA docs and the VA system? It is an entity in and of

itself and is unrelated to the private sector. The article should delved

into and tried to explain more about how practice patterns of private sector

docs change based on their reimbursement systems.

I know our LOS has decreased in PT and OT, but is has been more a factor of

the insurer stating that they would not pay past a certain date or number of

visits. Presented with that, patients always opt to D/C instead of private

pay. As a result, over time we have learned to plan for an average of six

visits for our outpatients. In inpatient we have a hospitalist that we

negotiate with, so we see some flexibility in LOS, but it is still greatly

reduced overall.

Mark Dwyer, MHA, PT

mdwyer1@...

Inpatient Admission and LOS

>From Modern Healthcare

>

> " A doctor's decision on whether to hospitalize a patient might be less

>influenced by financial incentives than previously thought, according to a

>study in the current New England Journal of Medicine. The study tracked

>chronically ill patients in the Department of Veteran Affairs healthcare

>system from 1991 to 1995. After controlling for disease severity and

>demographic factors, the authors found that patients in the Northeast spent

>up to three times longer in the hospital than those in the West. In the

>private sector, this pattern has been attributed to the prevalence of

>managed care in the West and its financial incentives to minimize inpatient

>days. The study's authors were surprised to find that while VA doctors

>receive the same salary regardless of their patients' utilization of

>services, their admitting patterns still mirror regional norms. "

>

>

>Any comments? Are you surprised? Is this what you've experienced?

>

>

>

> R. Kovacek, MSA, PT

>Email Pkovacek@...

>Visit <www.PTManager.com>

>

>TOGETHER WE CAN MAKE A DIFFERENCE !

>

>

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