A Washington doctors' group said yesterday it has saved the U.S. government $3 million in the past year by denying public payments for 626 patients who needlessly got 15,000 days of hospital care here.
The doctors also said more than $4 million erroneously was paid out on 19.015 days of equally inappropriate acute hospital care at more than $200 a day for another 759 chronically ill patients, just because no cheaper care was available.
The doctors blamed the federal government for the latter condition, specifically, its Medicare and Medicaid administrations for "foolishly" refusing to pay enough for chronic care, while paying out millions for expensive acute care for these patients.
Because of this "Penny wise, pound foolish" federal policy, the doctors said, the number of lower-cost chronic disease and nursing home beds in the District of Columbia has dropped from 1,559 in 1975 to 905 today.
On the basis of both its achievements in halting erroneous spending and in analyzing the factors contributing to rising health care costs the doctors' group - the National Capital Medical Foundation - called its first two years of operation a success.
The foundation is the District of Columbia "professional standards review organization" or PSRO - one of a national network of medical "watchdog" groups created by federal law to monitor hospital stays to try to cut costs.
Between 1975 and 1976 the Washington group's efforts helped cut the average length of stay for Washington Medicare patients from 14.4 to 13.4 days, according to its figures.
The Washington PSRO summed up its results at a news conference. The Department of Health, Education and Welfare today is scheduled to sum up one of the results of PSROs nationally.
A nearly final draft of HEW's report, (as summed up in Washington Report on Medicine Health, a weekly newsletter will show mixed results and maintain:
That only seven of 18 closely studied PSROs achieved reductions in hospital stays, and the PSRO system seemed to have no effect on hospital use nationally.
There also is no evidence PSROs have saved money in their two years of existence so far in most cities. Even where they have cut hospital stays, it has cost them $16 to $18, on the average, to review each patient's stay, with these federally-paid administration costs themselves adding up to millions.
There are some indications that PSROs have improved the quality of hospital care by requiring doctors and hospitals to keep better patient records and by creating even this partial new kind of review of doctors' performances.
All PSROs, including Washington's, use teams of specially trained nurses to review patients' records. The nurses, then MD-consultants, decide whether or not a doctor had good medical reasons to hospitalize a patient, and whether or not the patient is staying in the hospital too long.
The admitting doctor gets a chance to explain any deviations from normal admissions or stays, but the PSRO has final power to recommend denial of federal payments for Medicare, Medicaid and some other classes of public patients. So for most PSROs review the stays of only publicly-financed patients, though HEW officials have talked of extending the system to review all stays.
In cases where the Washington PSRO has denied federal payment for a hospital stay, "the federal government has saved money, but the public has not always saved," said Dr. Irving Burka, the Washington's group president. In some cases the patient managed to pay the bill, he explained, but mostly it went unpaid and the hospital had to make it up by adding to other patients' charges.
"In many cases, the patient needs some care but does not need acute hospital care," Burka said. This, he explained, is why "we are disturbed" to find the District of Columbia's 13 hospitals clogged with older and chronically ill patients who are there at a current cost of $239 a day, on the average, when the could be in cheaper, simpler facilities.
He blamed federal refusal to pay more than a "skimpy" $35 or so daily for most nursing home or chronic care for causing the number of nursing and chronic disease beds here to drop. He said "many urgent steps" are needed to correct this situation.