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The day you are admitted into the hospital, discharge is being planned. Along with the pressure to discharge patients quickly due to capacity issues, insurance companies play a large roll of early discharges. Early hospital discharges, and poor communication between health care services and inadequacies in the discharge process affect hospital readmissions. Today when a patient is admitted into the hospital, they are paid from insurance through a “payment system”. In 1980, the average hospital stay in the United States was 7.3 days. Today it’s closer to 4.5 days. Insurance companies have stopped paying hospitals whatever they claimed their costs were and now pay them a predetermined rate tied to each patient’s diagnosis (Frankt, 2016)). With advancements in health & medicine, the population majority of patients are the elderly with chronic conditions. Insurance companies see it more affordable to have patients be cared for outside of facilities, in their own homes, following up on outside visits, than the high costs of hospital stays. Nursing implications are to ensure discharge planning is understood to decrease time spent in hospital, improve patient outcomes and reduce costs, and readmission. Important to ensure the patient was capable of self-care following hospital discharge and scheduling a follow-up appointment, medication reconciliation, and nurse-led telephonic assessment for follow-up (Knutsen, 2019).