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The Compensation of Physicians Who Treat Patients Having Infusions at Home

Mark M. Applefeld, MD; Frederick J. Buckwold, MD; Kenneth M. Fisher, MD; Willard J. Ingram, MD; Dennis N. Nielsen, MD; Edward O'Rourke, MD
JAMA. 1990;263(9):1199. doi:10.1001/jama.1990.03440090029014.
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To the Editor.—  Today's cost-conscious health care environment poses several dilemmas for physicians, one being when and how to send a patient home from the hospital. The diagnosis related group system, with its emphasis on designated lengths of stay, can result in patients being sent home "quicker" but "sicker." Fortunately, with sophisticated, alternate-site health care services, many patients can now be treated at home. Home infusion therapy is a prime example of a cost-effective alternative to hospitalization for appropriate patients.Unfortunately, physicians may not prescribe home infusion therapy for these patients. To many, home care represents loss of control—a feeling of no longer managing their patient. In addition, many physicians have concerns about possibilities of litigation should any adverse events occur when the patient is outside the traditional hospital setting. Discharging a patient to home care may also represent a significant loss of income. Thus, there is little incentive for


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