How Bureaucrats Snarl U.S. Health Care : Some Try to Force Hospital Discharges Too Soon, Workshop Told

Patients are being “jerked around” by a health system more concerned about cutting costs than providing quality care, Marianne French, acting administrator of UCI Medical Center’s cancer unit, told a medical workshop Thursday.

In one typical case, she said, a Medicare “discharge planner” came to her just 48 hours after an elderly woman with breast cancer was hospitalized.

“We can’t help her here,” the planner told French. “Nausea, vomiting and dizziness do not constitute a reason to stay in the hospital” under Medicare guidelines for determining which expenses will be covered.

“If she stays in the hospital,” the planner said, “the patient will have to pay.”

Such ultimatums from non-medical personnel are becoming commonplace in U.S. hospitals, French told fellow health professionals Thursday at a workshop on medical economics sponsored by the Orange County unit of the American Cancer Society.

“When you’re faced with getting patients out of the hospital as soon as possible, as health professionals we are losing control of taking care of our patients,” French said.

Dr. James A. Pedova, a Tustin oncologist who is president of the Orange County Medical Assn., agreed.

Too often, Pedova said, Medicare and insurance company planners pressure doctors to discharge patients quickly, even though the patient still feels “he’s too ill to go home.”

“We’re talking about patients being removed from hospitals too soon, doctors being questioned by non-medical people when treatment decisions are made, and having to explain those decisions to some 800 number,” Pedova said.

The situation “is going to get worse before it gets better” because health care policy is not a priority for Americans, predicted Dr. Steven A. Armentrout, a UCI Medical Center oncologist who is president of the local cancer society chapter.

For now, the only way to fight the bureaucracy is for doctors to act as the patient’s advocate and resist pressure for an early discharge, Armentrout said.

“No one ever tells you to discharge the patient. They tell you, ‘We don’t feel we can pay for the patient’s care,’ ” he said.

“So you just don’t discharge the patient. You do your best to resist them. Sometimes these are subtle pressures from the hospital. But if the patient is medically impoverished, most hospitals won’t go to small claims court. They just eat the bill.”

Still, there are strong pressures on doctors not to buck the system, Armentrout conceded, because “a doctor who is an economic burden to a hospital will find his privileges are not renewed.”