The guidelines can be applied inappropriately in the field by health plans, hospitals and networks. They are not universal standards. They are strict and tight in regard to the use of resources. Some length of stay targets are unrealistic and physicians are uncertain as to when they begin in the course of care. The length of stay targets can only be met when an infrastructure is in place that creates efficiencies from admission to discharge.
Discharge delays can be beyond the control of the physician.
When applied to the general population as a whole, they can be difficult to attain. They do not allow for deviations and do not take co-morbidities into consideration. The guidelines do not consider the costs associated with readmissions due to discharges that are too early. The guidelines diminish reimbursement to physicians. They are not based on outcome studies, nor are they necessarily evidence-based.