Should hospital beds be kept full or empty?

Should physicians strive to keep hospital beds full or empty?

Obviously, in an economically optimal situation, just like in the hotel business, the hospital beds that are “needed” and available should be kept pretty close to full, in order to cover fixed costs and balance the hospital budget.

A recent discussion board on another physician website has called attention to an alleged practice of both emergency physicians and hospital administrators being paid bonuses for upping the number of admissions.

I suppose that could be one permutation of the “pay for performance” concept. But what if that patient could be cared for just as well at home?

A variation on this theme would be bonuses for keeping ICU beds full by fudging who actually needs them.

We all know that hospitals can be dangerous places to be.

I think such alleged practices fail the “smell test,” and may well be at least unethical, if not downright illegal.

My goal would be to keep the population well, treat illness on an ambulatory basis, until old people are ready for hospice care.

That way we could empty most hospitals.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit for more health policy news.

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  • Mike

    Alleged? Someone alleged that er doctors and hospital administration are in cahoots to admit people who do not need it? That allegation does not pass the smell test. Is there evidence of this allegation? That is a pretty brazen charge to be leveled in an article.

    • pj

      Well if it helps, my local hospital has several goals posted in one of the public hallways. Among them is, “Increase admissions by 15% over the next year.”

      No mention of medical necessity.

  • anonymous

    What about malpractice concerns? Where I trained, we did “defensive admits” in addition to the usual “defensive tests”, just in case that chest pain we thought was GERD actually did turn out to be an atypical MI.

  • Stalwart Hospitalist

    According to my experience with hospital administration, the proper answer to the blog’s title question is: both.

    • pj

      What??? Is that just cynicism? (Not that I would blame you- some administrators just can’t be pleased).

  • pcp

    Isn’t this the basic question that needs to be addressed in creating the rules for ACOs?

  • Marc Gorayeb, MD

    These are serious charges. Apparently based on rumor and innuendo. Without citing a shred of evidence, this is a bomb-throwing post that should have never seen the light of day.

    • pj

      Right Marc. And redundant beauracracies will legislate themselves out of existence, too.

      Please see my comment above.

  • jim jaffe

    I’m not a physician and claim no expertise on their behavior. but if I were affiliated with a troubled hospital and we had a symbiotic relationship, I can’t believe I wouldn’t lean toward hospitalization in marginal situations where I wouldn’t if the hospital was full and getting someone in was a challenge. paying bounties is an unattractive idea, but think the problem is broader and more cultural.

    • pj

      Sadly, here is a nonphysician who seems to have a better grip of the issue and the reality than do my colleagues.

  • Tom

    Well I think it should be wisely thought and there must be certain criteria that used to determine whether a patient should be cared in the hospital bed or not.

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