Hospitalization and how it is paid by "DRG."

Interesting. I know when Mom was in for a UTI she went in on a Tues., doing well on Wed when doctor examined her and discharged her. Thur went in and she was out of it breathing weird and everytime I went out to the Nurses station I was told she was discharged and she was going to Rehab. I was saying she did a 180. I knew Rehab would send her back. They finally got hold of the Dr. (which I persisted they call) he allowed one more day saying they would check out a nodule in her neck. Daughter showed up and found the antibiotic had penicillin in it which Mom was, according to hospital records, was allergic to.

Do people understand that in America most hospitals are not charities? They are not non-profit orgs? They, like any other business, have to operate in the green and make a profit so that it can plan for ongoing and future improvements, invest in very expensive newer technology, hire more/better staff, open more wings, pay the ever increasing liability bill created by our litigeous society and ambulance-chasing lawyers. This is not greed, this is how business works. Hospitals have very complicated software systems and formulas that they use to help navigate their complex -- and ever changing -- industry. I know because having worked with the med-tech sector since the 80s, I've been on a few hospital-related projects and written websites for clients who make those systems and software. Hospitals need to know where they lose and make money, and this means they need to have some sort of predictive ability for every patient's course of care. They learn or develop efficiencies, which are usually a good thing. Who wants to hang out in a germ-y place being poked and prodded every 15 minutes when you may be better off recovering in the comfort and safety of your own home? My husband had an emergency gallbladder removal this past Monday morning. Surgery ended at 11:30am. He went home at 3:30pm and was happy to do so. They took it out using laparoscopy, so no large incision, just 4 small holes glued shut. He has a much shorter recovery time because of it. The incentive to develop a better gallbladder removal procedure is: better outcomes that allow profitability. These are the incentives for *any* medical advancement. FYI, Medicaid reimbursement is very low and this is why most doctors and dentists don't accept it, and why Medicaid patients often don't receive the same quality of care when they do.

Unfortunately, this coding to get paid more, is also why our medical records aren't an accurate picture. This BS practice causes increases in insurance premiums for the individual being miscoded to get greater compensation.

I wish that billing was fair and honest, then we wouldn't have to have a system that games are played to get fair and honest payment.

So screwed up!