3. Two-Midnight Rule
Jerry Arndt, senior vice president for business services at Gundersen Lutheran
To Jerry Arndt, senior vice president for business services at Gundersen Lutheran, a 325-bed integrated healthcare organization based in La Crosse, WI, the two-midnight rule feels like a punishment for running a competent, well-managed shop.
"It's just another one of those absolutely classic examples of being penalized for being efficient. If you can discharge somebody with a one-night stay, then it will get paid as an observation as opposed to discharging them at 12:05 a.m.," he says. "It's another example of having to choose between doing what is right and what maximizes revenue, and this is really, really getting to be a difficult situation."