“Since the early 2000s, hospitals have been developing metrics to define high-quality care. In addition to readmission rates and the incidence of various iatrogenic infections, reducing hospital length of stay has been a popular target. Most people prefer nonhospital days to hospitalized days, and insofar as effective treatments hasten the return to health, it seems plausible to assume that shorter stays correlate with effective stays. As an ancillary benefit, shorter stays may cost less and increase “throughput,” resulting in more revenue for hospitals. Because tallying the length of stay is easier than quantifying high-quality care for heterogeneous “hospital problems,” patients with everything from congestive heart failure to new-onset lupus nephritis must meet the same metric. [..]
As the proportion of physicians employed by hospital systems and their “business majors” has risen, the ethos and priorities of hospital-based medicine have become increasingly influential. Physicians practicing in this context must embrace dual roles as both employee and advocate, working with hospital administrators to identify areas where corporate interests conflict with patient-centered care. The delays and frustration caused by “hospital problems,” for instance, highlight the importance of developing metrics that capture value for patients, even if they extend hospital lengths of stay. Longer term, transitioning to value-based payment models may break down the barriers currently separating inpatient and outpatient medicine. In the interim, physicians and hospital administrators should recognize the value of also treating the problems that merely benefit from hospitals.”
Full article, M Putman, New England Journal of Medicine, 2023.7.13