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Re: Robbing to Pay

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Interesting, !

In a grad. seminar a couple of years ago, a work group I was in evolved a wildly

reactionary strategy...

It revolved around the premise that home care, while it does get patients out of

the hospital, is somewhat inefficient in that professional staff does a lot of

traveling for relatively few patient contacts. Outpatient care requires the

support of multiple additional providers' overhead.

Hospitals want to vertically integrate (dominating the consumer's purchase of

all

health care related services.) As the insurors have forced hospital room rates

down, then locked them in with HMO contracts and Medicare agreements, those

cheap

overnight rooms might start looking good.

If the hospital has fixed physical plant costs and unused capacity (its supply

curve is low) and now faces low case rate reimbursement in home health, it might

become to the hospital's advantage to keep some of its patients a few extra days

in a place where there are nurses to do b.i.d dressings, aides to do bathing,

feeding, and personal care -- and of course, PTs to Stamp Out Disability! ..or

at

least get a bit more progress before heading to the house. That might actually

eventually be less costly. Eventually, the patient does go home with home

health

visits, but they'll require fewer visits for the fixed case-rate reimbursement.

A result might be to increase the use of the hospital's services.

Just wanted to share that viewpoint...

Dick Hillyer

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