Published in the August 2013 issue of Today’s Hospitalist
Are you afraid to admit patients?
OK, I admit that the word “afraid” may be an exaggeration, but maybe not that much of one. As our cover story explains, hospitalists everywhere are feeling the heat from payers and their own case managers to put short-stay patients in observation instead of admitting them. And according to the hospitalists we spoke to, payers are constantly expanding the parameters of exactly who qualifies for observation.
Here’s an example from our story: a hypotensive patient with new onset a fib treated with multiple antiarrhythmics. For most hospitalists, a two- or three-day stint for such a patient would be a no-brainer. But in the world of reviewers and RAC auditors, a short stay “even for something as tricky as a fib “is an ideal candidate for observation.
These reviews are particularly frustrating because while physicians must make decisions at the bedside in the heat of the moment, auditors have the benefit of 20/20 hindsight. After the fact, it’s easy to see that the patient’s chest pain never really turned into a serious problem, and that observation would have been fine.
Payers and their hired reviewers still ostensibly defer to physicians, who are on the front lines, as to whether patients should be admitted. But that’s not stopping payers from coming back, sometimes after a year or two, and second-guessing those decisions.
Our article points out some steps physicians can take to help auditors understand why an admission is warranted. (You probably won’t be surprised to hear that the trick is thorough documentation.) But the bigger point of the story is that the kind of muscle being exercised by reviewers and auditors is a sneak peak at the brave new world of a changing health care environment. As much as you may not like oversight, this could be just the beginning.
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