Better prevention, new medications, advanced technologies, and the sophisticated care that modern hospitals provide to patients are just some of the ways that hospitals are improving the care they deliver to their communities, which have led to shorter hospital stays.  A recent column suggests there are other reasons behind the shorter stays. The bottom line is that the decision to admit or discharge a patient is a complex medical decision between a patient and physician.

However, there are other factors at play.  It is no coincidence that the increase in observation services occurred with the advent of the Recovery Audit Contractors (RAC) program.  Too often, the medical judgment of treating physicians was second-guessed by RACs, which could evaluate a patient’s admission in hindsight, looking at the entire medical record rather than only the information that was known to the physician at the time of the admission. Fortunately, CMS has moved to curtail the egregious behavior of the RACs.  The numbers show that readmissions are on the decline thanks to the hard work of America’s hospitals to improve care, provide better discharge instructions to patients and partner with patients and others in their communities to coordinate care after they leave the hospital. This success can continue as patients and physicians together make decisions about their course of care.