Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
To the Editor.— I disagree with several points raised in the Editorial by Dr Zuckerman1 commenting on the article by Dr Munin and colleagues.2 When I was an orthopedic resident 25 years ago, it was not unusual to keep patients in the hospital for 2 to 3 weeks following total knee and hip replacement surgery. Hospitals gained from the cost-plus basis of presurgical admissions and long postoperative hospitalizations. The diagnosis related group (DRG) system did change this, but did not change the fact that patients still need time to heal. I agree with Zuckerman that the shorter lengths of stay and the financial incentives from DRGs encouraged the explosion of rehabilitation in the 1980s. But this explosion was fed by the need for the rehabilitation services, which, if not provided at the acute care hospital, was to be done elsewhere. To condemn a hospital for providing a needed service and generating revenue is absurd.
Levine AM. Rehabilitation After Hip and Knee Arthroplasty. JAMA. 1998;280(16):1402-1403. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-16-jbk1028