It Takes Time to Get Well

Ocean County Observer

June 13, 1983

Dr. George Triebenbacher, a practitioner on Long Beach Island and an Assistant Ocean County Medical Examiner, dropped a bomb almost as an afterthought at the annual meeting of the New Jersey State Medical Society. At the very end of the meeting he gained the microphone and stated that it seemed to him in performing his function as medical examiner, that there was an increase in the number of people who had died or suffered relapses soon after release from a h hospital. He added that he felt that some of those cases might be related to DRG.

DRG is an acronym for Diagnosis Related Grouping, a legacy of the Jo Ann Finley reign as Commissioner of Health under Governor Byrne. Under this system hospitals are reimbursed on the basis of diagnosis rather than on length of stay. The system is statistically complex but basically each diagnosis is accorded a length of stay and the hospital gets paid on that basis. If a patient is discharged before, the hospital keeps the extra money. If the patient is discharged after the target date the hospital must assume the extra costs. It is not clear whether the hospitals are allowed to pass the extra cost on to the patient. One thing is clear. If the patient leaves before the target date the patient is not reimbursed the difference.

Back to Triebenbacher. His statement at an otherwise dull meeting made headlines and now there are some investigatory committees and watchdog groujps established to see whether Dr. Triebenbacher was correct.

The fact is that the DRG system does put pressure on the doctor to get the patient out of the hospital earlier than he otherwise might have had. Hospital administrators are only too eager to instruct doctors in DRG procedure; how to order tests, how to order blood so that there is no waste (no one counts how many times delay in ordering blood could leave a blood bank dry) , and when to discharge a patient. “Of course it’s your say, doctor, but if the patient stays too long we will lose money.

This encourages doctors to factor costs into medical decisions. We find ourselves subliminally shifting our criteria to satisfy the demands of the system. And of course that victimizes patients.

Last week a hospital in this county admitted in one day, four patients who had been discharged from the hospital that same week. This represents considerable coincidental relapse.

The fact is that DRG was not evaluated with respect to patient care, and as Assemblyman Hardwick stated, “We only voted on establishing a rate-setting commission and that was pushed through without legislators fully understanding its implications.”

We always thought that legislators were paid to understand what they were voting for or against. Apparently that is a misconception.

When should a patient leave a hospital? When both the doctor and patient feel the time is right. Not when the State of New Jersey decides.