Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The evolution of a hospital admission

John Schumann, MD
Physician
August 17, 2016
103 Shares
Share
Tweet
Share

Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce.

The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really — if you had it).

This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for hospitals changed. With DRG payment, the hospital would get one bundled payment for the whole hospitalization based on the patient’s diagnosis. The average length of stay for hospitalized patients went from thirty days. (Imagine: a month(!) in a hospital.) Hospital executives saw the need to minimize length of stay: Depending on the payment for each diagnosis, there would be an inflection point when a patient staying beyond a certain number of days would result in financial loss.

“Throughput” became the term of art. (Like widgets on an assembly line.)

Now the average time someone spends in a hospital is a little more than four days. (Of course, for mothers with normal births, this is even less: about two days. Many surgeries that used to necessitate several days in the hospital are now done on an outpatient basis. Length of stay in those situations: zero.)

A recent essay on this topic in the New York Times by Dr. Abigail Zuger brought back memories for me. I once had a teacher tell me, “No one should ever need to be in a hospital. Except for some cardiac conditions that require immediate care, the only people winding up in hospitals are frail elders, and those with social problems and no place to go — the mentally ill, the destitute, the homeless.”

I remember feeling a bit shocked by this, but as I reflected on it, I realized he had a point. I should start with the assumption, he told me, “That almost no one really needs to be there, and they’re better off at home.”

The modern condition leads us to keep people in hospitals for as short a duration as possible. But something is clearly lost. As Dr. Zuger writes:

Hospitals were where you stayed when you were too sick to survive at home; now you go home anyway, cobbling together your own nursing services from friends, relatives, and drop-in professionals.

Patients often go home feeling brutalized by all the blood draws, hospital food, and lack of sleep. Rare is the patient who says, “I feel better now; can I go home?” Often we send them home before they feel ready.

It sounds a bit cruel, and like there’s a perverse incentive at play. But keeping people in the hospital is also inherently risky. Hospitalization can cause infections, loss of muscle and coordination (especially in older folks), falls, and delirium. So getting people out as quickly as possible is in many ways the right thing to do.

The truth, however, probably lies somewhere in the middle.

John Schumann is an internal medicine physician who blogs at GlassHospital.

Image credit: Shutterstock.com

Prev

Can chiropractors be saved? Only they can decide.

August 17, 2016 Kevin 11
…
Next

When should physicians lie for patients?

August 17, 2016 Kevin 5
…

Tagged as: Hospital-Based Medicine

Post navigation

< Previous Post
Can chiropractors be saved? Only they can decide.
Next Post >
When should physicians lie for patients?

More by John Schumann, MD

  • Doctors as the gatekeepers of marijuana is a race to the bottom

    John Schumann, MD
  • Rallying at the end of life

    John Schumann, MD
  • This inspiring doctor proved Zika virus doubters wrong

    John Schumann, MD

Related Posts

  • Don’t judge when trainees use dating apps in the hospital

    Austin Perlmutter, MD
  • When physician pay packages become hospital kickbacks

    Jordan Rau
  • 5 challenges of working in a county hospital

    Pranav Sharma, MD
  • Hospital administrators thinking about no-cost treatment which really helps patients

    John Corsino, DPT
  • What do hospital discounts really mean?

    Robert S. Berry, MD
  • Redefining what a hospital library should be

    Abeer Arain, MD, MPH

More in Physician

  • How my patients’ Zoom backgrounds made me a better doctor

    Joseph Barrera, MD
  • Understanding reproductive rights: complex considerations

    Anonymous
  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Practicing medicine with conviction

    Arthur Lazarus, MD, MBA
  • The power of memory in shaping human identity

    Emily F. Peters and Sandeep Jauhar, MD, PhD
  • Physicians have no autonomy. Here’s how to change that.

    Diane W. Shannon, MD, MPH
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Everyday dangers unknowingly impacting our health

      Tami Burdick | Conditions
    • A shop teacher’s daughter on transforming patient safety

      Barbara L. Olson, RN | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 26 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Woman Develops Chorioretinal Anastomosis at Site of Photocoagulation Scar
  • Pharmacists Improve Diabetes Control for Hispanic Patients
  • Clean Up the COVID Booster Mess by Returning to a Single-Payer System
  • Want to Improve the Patient Experience? Let's Start With Discharge Planning.
  • Hot Flashes: Precursor to Alzheimer's Disease?

Meeting Coverage

  • Hot Flashes: Precursor to Alzheimer's Disease?
  • SABR Offers New Hope for Older Patients With Inoperable Kidney Cancer
  • Menopausal Women With Obesity Endure Worse Symptoms, Less HT Relief
  • Study Pinpoints Growing Use of Cannabis to Manage Menopause Symptoms
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Communication, power dynamics, and organizational culture in health care

      Beth Boynton, RN, MS, CP | Conditions
    • How my patients’ Zoom backgrounds made me a better doctor

      Joseph Barrera, MD | Physician
    • Understanding reproductive rights: complex considerations

      Anonymous | Physician
    • Innovations in surgical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Everyday dangers unknowingly impacting our health

      Tami Burdick | Conditions
    • A shop teacher’s daughter on transforming patient safety

      Barbara L. Olson, RN | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The evolution of a hospital admission
26 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...