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Two-Midnight Rule Creates Financial Hurdles, Perverse Incentives

Rene Letourneau, for HealthLeaders Media, September 30, 2013

However the numbers shake out after Baton Rouge General completes its modeling, the hospital is taking steps now to prepare for the new rule, Johnson says. "The first [step] was to meet with our physician leadership to educate them on this change and to work collaboratively to amend our processes…[W]e will also work with our physician leadership to educate the other admitting physicians."

Additionally, the hospital is tightening up its intake processes. "We also have increased our staffing in care management to provide for 24/7 intake nurses to make sure that we correctly input the status of the patient on the front end of the process," Johnson says.

Choosing Between Right and Revenue
In the end, says Gundersen Lutheran's Arndt, healthcare leaders know they have to come down on the side of doing what is right for the patient, regardless of the potential financial implications for the organization.

"The balance is between doing what is right versus maximizing revenue, but you have to live with your conscience every single minute," he says.

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1 comments on "Two-Midnight Rule Creates Financial Hurdles, Perverse Incentives"


Myers Glower Michelle (10/1/2013 at 11:41 PM)
All the more reason for nursing care managers to review all admissions from the ED at point of entry to get the admission status correct. However, it cannot stop there. As the patient enters the system, further testing, may reveal more information resulting in a dx that converts to inpatient. In addition, patient objective symptoms may equate to conversion as well. It will take concurrent reviews at 100% through a time sensitive process. Physicians will need to be on board and hospitalist can no longer use two days as a work up for the what if's? Potentially this can have a huge impact on patient satisfaction scores and liability in discharging within the two day rule.