Shorter Hospital Stays for Heart Bypass Surgeries May Shift Cost From Hospitals to Nursing Homes, Study Finds

Coronary bypass patients spend about half as much time in the hospital after surgery as they did a decade ago, but the "increasingly" briefer stays may not save the health care system "much money" because they require greater use of outpatient or continuing care services according to a new study published in the May issue of the Journal of Thoracic and Cardiovascular Surgery. The Boston Globe reports that many hospitals have adopted fast-track protocols for coronary bypass patients, meaning that patients who quickly meet "daily goals" such as feeding themselves and having a stable heart rate have a chance of being discharged earlier (Saltus, Boston Globe, 5/1). The study tracked 786 coronary bypass patients at the Boston Medical Center. Of these patients, 407 had undergone surgery in 1990, before the implementation of early "extubations" or fast-track protocols, while 379 had undergone surgery in 1998, when these protocols were in place. The study found that although the length of an average patient hospital stay had dropped from about 10 days in 1990 to about five days in 1998, only 56.7% of the 1998 group were discharged home, compared to 97% of the 1990 group. Forty-three percent of the 1998 patients were discharged to extended care facilities, where they stayed about 10 days. Only 2.9% of the 1990 patients were discharged to these facilities. In addition, 5.3% of the 1998 patients had to be readmitted to the hospital at a later date, compared to 0.5% of the 1990 group. The researchers concluded that although early extubation and fast-track protocols have resulted in earlier discharge from acute care facilities, the "anticipated earlier return to home has been offset by the increased use of outpatient nursing services, discharges to extended care facilities and hospital readmissions" (Lazar et al., Journal of Thoracic and Cardiovascular Surgery, 5/1).

Costs Shifting, Not Disappearing
Although the research team did not compare the overall costs of hospitalization with those of rehabilitative care, lead study author Dr. Harold Lazar of Boston Medical Center said that shorter hospital stays that end in discharge to other nursing facilities represent "cost-shifting" rather than "cost-saving." He said, "It looks good that [patients] are staying less time in the hospital, but really, they're spending time in another setting. ... The concept of going to rehab isn't necessarily bad, but the data show there may be a false sense [of saving money]." But Dr. Gordon Blackburn, director of cardiac rehabilitation at the Cleveland Clinic Foundation, said that for most patients, receiving nursing care at home for rehabilitative tasks "is better than being in the hospital." He added that shorter hospital stays are also the result of the "ratcheting down" of reimbursements by health insurers and "other third parties" and improvement in scientific techniques and drugs (Boston Globe, 5/1).