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We Love You. Now Go Home.

Do you remember the movie featuring a horror hotel described as easy to check into but difficult to leave...alive?  Expect a remake someday, but with a hospital setting.

Improving post-discharge care and avoiding preventable readmissions is the subject of an article in  today's New York Times, finding that the process is often rushed, chaotic and uncoordinated.
"Hospitals tend to focus their efforts on the admissions process, because that’s when the patient is most sick,” said Dr. Mark V. Williams, one of the authors of the (NEJM) study. “The discharge process can be just as important but rarely gets the same level of attention.”
Dr. Williams is right about the focus but wrong about the reason - which has little to do with the severity of the patient's illness.  In determining why hospitals focus where they do, a good rule of thumb is always follow the money.

Where does it lead?  Right to the admitting process, so critical to determining what a hospital is paid for its labors (if anything.)   And that's where financially-stressed, revenue cycle-obsessed hospitals will focus until something else matters more.

Need a new focus? You'll need new schemes with incentives for rewarding VALUE delivered during and after the inpatient stay.  No more upfront 'pay per click" but after-the-fact 'Pay for value at 30 days post-discharge.' 

Change the money flow and, like a re-focused laser beam, watch hospitals STOP asking at admission "Will we get paid?" and START asking at discharge "Did we do this patient any good and how do we maintain the clinical momentum?"

In short, make the discharge process matter to PAYMENT and watch it matter to HOSPITALS.

By the way, this is my 400th post.  Thanks for reading!

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