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

Is there a link between readmission and a hospital’s non-profit status?

David Lozar, MD
Policy
December 10, 2019
Share
Tweet
Share

It was the middle of winter in downtown Chicago in 1995, and I was sitting across from an apologetic alcoholic holding a slimy NG tube. Mr. Smith, an emaciated man in his sixties, had been on my service for three days with acute pancreatitis, and this was the fifth nasogastric tube that had “slipped” out of his nose.

Subsequently, his morning labs were just as bad as they had been on admission, and my chief resident was not pleased. This was Cook County Hospital. We were supposed to admit, treat, and discharge. Beds were at a premium, and my inability to fix Mr. Smith was keeping someone else in an ER hallway. The solution, I was told, was to “bridle” the NG tube — and not to let Mr. Smith know what I was up to until it was done.

This technique consisted of passing a red rubber tube down each of his nostrils, suturing them together in his mouth, and then pulling one up and out so that a single tube bent around his nasal septum. Removing the second tube and suturing the first to itself, I passed the sixth NG tube and sutured it to the red rubber tube. Although bridling is used in pediatrics and ICU patients who inadvertently dislodged their device, I was using it to undermine Mr. Smith’s objective and, by the end of the procedure, he was well aware of it.

“Hey,” he complained, “that’s not fair!”

“If your tube keeps coming out, your pancreas is going to get worse. I’ll take it out once your numbers look better.

Two days later, I was doing just that.

“That was a sneaky trick you pulled,” said Mr. Smith with an easygoing wink. “I’ve been in here a lot, and that’s the first time anyone’s done it.”

“Do you feel better?”

“Yeah,” he said as he pulled on his unwashed jeans and thin coat. “But, I won’t fall for that one again. See you around, Doc.”

At the time, I was proud to have done my job and undercut my patient’s plan to stay sick. Now, I know I missed the boat.

I failed to see past my standardized training, the business model that said my duty was to discharge patients with good numbers as quickly as possible, and so didn’t see Mr. Smith’s side of things. The hospital provided a warm bed, clean clothes, and human interaction — things he had no other way of attaining. When I suggested he stop drinking, it earned me a colorful declarative and an eye-roll. Cheap booze kept him warm when nothing else would, and he only played his hospital card when it got too dangerous on the street. A “frequent flyer,” Mr. Smith’s routine was well known to the staff, and all my little procedure had done was kick him out into the snow a few days earlier than usual.

Twenty-five years later, I worry physicians are having an even harder time seeing the world with Mr. Smith’s eyes. Indeed, we are the comic sailors frantically patching holes in a ship floating on an ocean of acid. Alas, unless we tackle the real cause of our patients’ medical conditions, nothing will keep us from sinking. In addition to encouraging our patients to quit smoking, we should be passing laws that prevent tobacco lobbyists from influencing our elected officials. Instead of lambasting our patients for not taking their medications, we should acknowledge their justified fear that Big Pharma does not have their best interests at heart. Instead of discharging at-risk patients back into the world from which they came, we should be doing more to change that world. Otherwise, they bounce back like a rubber ball thrown against a schoolhouse wall.

Medicare designed its Hospital Readmission Reduction Program (HRRP) to reduce payments to hospitals with excessive readmissions. But health care is a business, and so hospitals write these penalties off as losses on their taxes or recoup their costs by increasing hospital charges for the general public. An alternative, and potentially more effective, program would have hospitals lose their non-profit status if their readmission rates didn’t fall. Doing this would essentially bridle hospital profits to the welfare of the community and incentivized them to knock down the walls their rubber balls are bouncing against.

ADVERTISEMENT

I saw Mr. Smith again as he was wheeled to the OR for a gunshot wound to the belly. He was wearing the same jeans and thin jacket I’d discharged him with two weeks earlier, and he winked at me as he passed as if to say he was somehow more prepared for this admission than the last.

I’d like to say he was right.

Instead, he died on the table that night.

I don’t want another Mr. Smith to be discharged into the snow with nothing but cheap booze to keep him warm. If we want our patients to do more, we have to do more to help them, and that can only happen when hospitals see profit in treating their patients as well as the community in which they live.

David Lozar is a family physician and author of Technology and the Doctor-Patient Relationship.

Image credit: Shutterstock.com

Prev

Negotiating lower drug prices in America: The tradeoffs are worth it.

December 10, 2019 Kevin 3
…
Next

A letter to a cancer patient in palliative care

December 10, 2019 Kevin 0
…

Tagged as: Hospital-Based Medicine, Medicare, Public Health & Policy

Post navigation

< Previous Post
Negotiating lower drug prices in America: The tradeoffs are worth it.
Next Post >
A letter to a cancer patient in palliative care

ADVERTISEMENT

More by David Lozar, MD

  • A solution to reduce defensive medicine

    David Lozar, MD

Related Posts

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

    Austin Perlmutter, MD
  • 5 challenges of working in a county hospital

    Pranav Sharma, MD
  • What do hospital discounts really mean?

    Robert S. Berry, MD
  • Why hospital mergers are destined to fail

    Robert Pearl, MD
  • How to choose the right rehab option after a hospital stay

    Edward Hoffer, MD
  • The story of how a hospital is being sacrificed for money

    Niran S. Al-Agba, MD

More in Policy

  • Why nearly 800 U.S. hospitals are at risk of shutting down

    Harry Severance, MD
  • Innovation is moving too fast for health care workers to catch up

    Tiffiny Black, DM, MPA, MBA
  • How pediatricians can address the health problems raised in the MAHA child health report

    Joseph Barrocas, MD
  • How reforming insurance, drug prices, and prevention can cut health care costs

    Patrick M. O'Shaughnessy, DO, MBA
  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • How humor builds trust in pediatric oncology

      Diego R. Hijano, MD | Physician
    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why “the best physicians” risk burnout and isolation

      Scott Abramson, MD | Physician
    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | 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 3 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

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • How federal actions threaten vaccine policy and trust

      American College of Physicians | Conditions
    • When the clinic becomes the battlefield: Defending rural health care in the age of AI-driven attacks

      Holland Haynie, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
    • How humor builds trust in pediatric oncology

      Diego R. Hijano, MD | Physician
    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Putting food allergy safety on the menu [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • Why “the best physicians” risk burnout and isolation

      Scott Abramson, MD | Physician
    • Why the Sean Combs trial is a wake-up call for HIV prevention

      Catherine Diamond, MD | Conditions
    • Why real medicine is more than quick labels

      Arthur Lazarus, MD, MBA | Physician
    • New surge in misleading ads about diabetes on social media poses a serious health risk

      Laura Syron | 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

Is there a link between readmission and a hospital’s non-profit status?
3 comments

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

Loading Comments...