Tuesday, November 06, 2007

A co-worker told me about this, and I've just spent a bit of time playing with it. Not surprisingly, if you've been reading my earlier posts, I've been looking at the costs generated by UCLA and UC Irvine. Here's an interesting table that I've generated.

What's going on here? One will note that some institutions charge more than others per day in the hospital. Sometime, that makes sense. The University of Chicago, for example, treats the sickest of the sick, has generated a large number of Nobel prizes in the process of learning how to treat the sickest of the sick, and has pioneered healthcare procedures used elsewhere. All that would be expected to cost more per day of hospitalization. Another way to put this is from the medicare / insurance companies point of view: payers are generally willing to pay more for specialists, and treating hospitalized patients with a lot of specialists is expensive.

(Of course, I'd like to point out that it's interesting that UC Irvine has such a high reimbursement rate per day, denoting a lot of work done by specialists. After all, this is the institution where the chair and vice chair of the Department of Cardiology were not board certified in anything, including internal medicine or cardiology, and did not have California medical licenses. It's also the institution that fired and allegedly blackballed the whistleblower who pointed out that they were billing for procedures allegedly performed by doctors who were documented not to be in the hospital at the time the procedures were performed. Do the specialists for whom UC Irvine is charging really exist?)

With some exceptions, it's reasonable to assume that that high inpatient reimbursement per day implies actual high use of specialists. Of course, the whole point of using medical specialists for inpatient care is to get people better quickly, so they can go home. Despite treating the sickest of the sick, the U. of Chicago keeps people in the hospital for only about the same time as the national average. It appears that the U. of IL, UCLA, and, to a lesser extent, UC Irvine, keep people in the hospital much longer than the national average. Other tertiary care centers (such as the U. of Chicago, and UCSF) don't do that. Why is that? Does the terrible weather in LA and Orange County mean that people have to be kept in the hospital, and thus out of the weather, longer than if they were in Chicago or San Francisco?

My guess as to the reason for the higher than average days of hospitalization generated by some hospitals can be intuited by reading about my experiences working for UC Irvine described in part II of this post. The kind of behavior I wrote about there could easily be responsible for the fact that UCLA (as well as other institutions) kept people in the hospital for almost 1 1/2 times as much time as the national average during the last 2 years of life. And, of course, that, combined with high billing rates, leads to a large income for the hospitals involved, without the benefit (to the patients) of getting better quickly and going home.

Just a thought.

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