For the second year in a row, hospitals across the nation are facing the prospect of forfeiting millions of dollars in Medicare reimbursements for readmitting patients too soon after their discharge.
That has motivated hospitals to take aggressive action to avoid the penalties allowed under the Affordable Care Act, and their efforts are beginning to pay off in the Dayton area and throughout southwest Ohio.
Over the past year, “we’ve decreased unnecessary readmissions by over 25 percent across all of our network hospitals,” said Teri Sholder, chief quality officer for Kettering Health Network. “We’ve partnered with post-acute care providers in our service areas…to bring improved care coordination across our communities.”
Kettering was instrumental in forming the West Central Ohio Care Transitions Coalition and the Community Care Connection Program to address factors that contribute to unnecessary readmissions. The program networks local hospitals, health departments and social service agencies.
The program’s “transition coaches” spend hours with post-acute care patients reviewing their medications and making sure they understand how to care for themselves after they leave the hospital.
The program started in January 2012, the first year in which the Centers for Medicare and Medicaid Services began withholding a percentage of Medicare reimbursements to hospitals with high readmissions rates.
In Ohio, at least 140 hospitals started seeing their payments reduced on Oct. 1 last year, including more than two dozen hospitals in southwest Ohio.
The cuts totaled more than $280 million in payments for hospitals that had 30-day readmission rates for patients suffering from pneumonia, heart attack or heart failure that were higher than expected based on CMS’ risk-adjusted formula.
Kettering’s readmission penalty was “non-significant for the organization,” Sholder said. But the hospital network remains focused on programs that help all patients avoid readmission, she added.
Byran Bucklew, president and chief executive of The Greater Dayton Area Hospital Association, said hospitals need to keep readmissions under control, in part, to avoid paying stiffer penalties down the road.
Readmission penalties will increase over time from up to 1 percent of reimbursements in fiscal year 2013, which began last October, to as much as 3 percent of reimbursements next year. And while hospitals have always been concerned about post-acute care, Bucklew said, the penalties have provided a strong financial incentive for them to step up their efforts.
“What you’re seeing is all providers, including hospitals, spending more time and resources with patients on follow-up care,” he said. “But a lot of the issues with patients getting readmitted are not the result of the provider or the hospital but the lifestyle decisions of the patients.”
The challenge for hospitals in many cases is simply communicating instructions for follow-up care to patients after their discharge and getting them to take their medications, said Tammy Lundstrom, chief medical officer for Premier Health Partners.
“We try to identify those patients that we think are at higher risk of readmission,” Lundstrom said.
To that end, the hospital employs a training tool known as “teach back,” in which a nurse provides a patient instructions about care at home, and then has the patient repeat the instructions back to the nurse one or more times, Lundstrom said.
In addition, the nurses call high-risk patients on the second day of their discharge and then 10 t0 14 days later to “reemphasize” their instructions.
“We started these programs in May of last year, and we’ve been refining them since then,” Lundstrom said. “We have seen significant improvement in readmission rates, but the biggest thing is that we feel like we’re really meeting the patient’s need in a more thorough way than we were before we started all these initiatives.”
Hospitals across the country are trying various approaches to figure out what works best.
In Cincinnati, Christ Hospital Health Network announced this week that it has entered into a joint venture with Alternate Solutions Healthcare System to provide post-acute health care services for adults in their homes.
“We’ve been actively working on issues surrounding readmissions for over three years, but having our own home health agency is just one of many tactics that we’ve gone to,” said Tim Crowley, executive director for geriatric services at Christ. “We track our readmission rates on an ongoing basis, and we’ve really moved the rates down to lower levels since we’ve been concentrating our effort on that.”
Crowley said the hospital network’s readmission rate is down to about 16 percent from 20 percent just a few years ago.
While he has no real objections to the government’s efforts to lower readmissions rates by penalizing hospitals based on their performance, Crowley thinks the formula for accessing the penalties is unfair.
The penalty is based on a three-year rolling average of readmissions, starting in 2009.
“So you’re getting penalized for something you can do absolutely nothing about,” Crowley said.
The Dayton Daily News has aggressively reported on the new health care law’s impacts on hospitals and the public.