amane kaneko
Are hospitals going to be allowed to start “patient profiling” in order to reduce costs? Hospitals already frequently operate their own state departments and perform “extraordinary medical renditions” on uninsured, critically ill noncitizens. Do you really expect us to believe they are identifying these patients in order to provide them more appropriate services? My impression is that since this group has been identified as a cost driver, the aim of any intervention is saving money for the hospital rather than rendering appropriate care.
—Tom Horiagon
Dr. Hospitalist responds:
As hospitalists, we are best positioned to manage the balance among medical, social, and fiduciary responsibilities. The article addresses the data that shows what most of us already know: Most patients who have multiple readmissions have many co-morbid conditions and/or psychiatric and social issues. Hospitalists have the opportunity to use everything in the patient’s history and profile to prescribe the appropriate treatment plan. When we find the right solutions, it would be helpful to us all if they were not only cost effective but also right for the patient.
Although I prefer to not use the term “patient profiling” because of the associated negative connotations, I do believe there are occasions we face with our patients when the most “appropriate service” may not be clinically relevant at all.
For example, we recently began a quality initiative project in our hospital to identify those with acute or chronic pain and the most frequent admissions (greater than 10) in a calendar year. We identified a patient who had a total of 43 admissions across four different hospitals in one calendar year. Clearly, the best care for this individual would be to get him an apartment.
We know that many of these “frequent flyers” tend to absorb vast amounts of our healthcare dollars with multiple imaging studies, lab work, and time taken away from other patients, not to mention the emotional toll some of these patients take on the clinical staff.
Discussions on such matters as tort reform, futile care, and patient nonadherence (many factors and much more complex) have been going on for some time. I don’t see our politicians developing the intestinal fortitude to address these problems any time soon. With our national healthcare expenditures reaching $2.9 trillion (or $9,255 per person in 2013, per cms.gov), who is best situated to make ground level changes than hospitalists? It really doesn’t matter whether these patients are insured or uninsured, whether they are citizens or noncitizens, or whether “an intervention is saving money for the hospital.” In the end, many are utilizing more than their share of medical allocations, and we as taxpayers get to cover that cost.
I believe we can be good doctors and, at the same time, good stewards of our nation’s healthcare dollars.
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