Steven E. North, Esq. and Laurence M. Deutsch, Esq.
Despite denials by many physician’s, full-time hospital employees are often urged or incentivized to perform more procedures than they might in order to increase hospital income or facilitate education. When it is obvious that unnecessary procedures are being done for either of these reasons, the soil is ripe for medical malpractice suits. It is, however, often difficult to establish that an elective procedure was unwarranted, particularly if a physician maintains that the patient was insistent upon having it.
Another pressure imposed on hospitals with a trickle-down effect to primary care physicians comes from the Center for Medicare & Medicaid Services, which “encourages” physicians to avoid readmitting patients “unnecessarily.” In fact, heavy financial penalties are imposed on hospitals whose readmission rates are considered too high – even if the cause for readmission is beyond their control.
If, for example, a patient was discharged from the hospital and subsequently developed an infection, pneumonia or other condition beyond the hospital’s control, the hospital is nevertheless held financially accountable for the readmission. This not only seems absurd, but also creates a conflict of interest when such a patient presents to the emergency room.
Furthermore, if a patient remains hospitalized longer than his or her third-party carrier deems “reasonable,” it may deny payment for the extended part of the stay. Indeed, there are charts of allowable stays for particular conditions, and longer stays are not compensated. So, if the hospital wants to keep a patient for a day or two to be sure that recovery is sufficient and the patient is stable, reimbursement for those days will be denied. Yet if a hospital discharges a patient prematurely and the patient has to return, the hospital will be penalized in that instance too. The balancing act may not always work to a patient’s advantage.
Doctors are advised to encourage patients to self-manage their conditions to avoid readmission to the hospital, but such recommendations often have little impact on patients, particularly the elderly.
These circumstances create fertile soil for medical malpractice litigation and have enabled this office to successfully prosecute numerous malpractice suits based on the failure of a hospital to admit, readmit or discharge at a time that is optimal for recovery.
Source: Medscape: “More Pressure of PCP’s to Reduce Hospitals Readmissions,”
March 4, 2015
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