Constrained Innovation in Managing Care for High-Risk Seniors in Medicare + Choice Risk Plans. 4. Technical Change and Patient Expectations


Several seniors in the focus groups expressed difficulty dealing with some of the recent advances in medicine. In particular, it appeared that many had difficulty adjusting to new regimens that enable some complex medical conditions to be treated outside a hospital. These methods have induced insurance plans (including Medicare) to create incentives to shorten the length of hospital stays and to encourage treatment in the least-expensive feasible environment. Thus, patients are discharged from hospitals quicker, with some going to nursing homes and others going home. In many cases, the seniors do not feel ready for the move. Many also have expectations based in times when long hospital stays were much more common. As a result, seniors reported finding themselves in situations where a physician’s or MCO’s judgment about what was medically necessary differed from what the patients felt they were ready to handle:

I think it’s awful when they send people home that are so sick. They don’t care if they live or die. And then they took him out and they put him in the nursing home when he was so sick. I think this is terrible.

My husband was very ill and sent to St. John’s Hospital. I thought he was going to die. He looked just terrible. So they called me up and said, he’s ready to be released. Here he had pneumonia and had a high fever and I had to take him back. And it wasn’t long after that that he was right back again. So all this money of transporting them and all this, I just don’t get it.

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