Few hospitals meet standards for reducing readmissions

(Pittsburgh Post Gazette) Historically, a patient who has to be readmitted has meant more revenue for a hospital, since it would receive payment for each stay. Under provisions of the 2010 Patient Protection and Affordable Care Act, however, hospitals now are penalized if their readmission rate is too high.

Grove City Medical Center has been doing a better job than most at preventing those return trips to the emergency room.

Through an array of programs instituted since 2009, the 89-bed hospital in Mercer County has about halved its 30-day readmission rate — from an industry standard 15 to 20 percent to between 6.3 and 8 percent.

As a result of its success, Grove City was one of only four area hospitals cited by the Centers for Medicare and Medicaid Services (CMS) for meeting the standard for reducing unnecessary readmissions.

“They’ve done a lot of work smoothing the transition between the hospital and the nursing home,” said Jane Montgomery, vice president for clinical services and quality for the Hospital Council of Western Pennsylvania.

And “we’re not done,” says Brad VanSickles, Grove City’s vice president of operations and patient safety. “We can never say we’ve achieved this. What we say is, ‘We’re making progress with it.’ ”

While no hospital wants a patient to be readmitted within 30 days, the penalties for readmissions are meant to encourage hospitals to aggressively try to prevent them.

In this first round of CMS payment adjustments, the percentage change in reimbursements for readmissions regionally ranged from no penalty for Grove City; ACMH in Kittanning, Armstrong County; Advanced Surgical Hospital in Washington, Pa.; and DuBois Regional Medical Center, Clearfield County, to a 1 percent penalty for Allegheny Valley Hospital in Natrona Heights and Excela Health Frick Hospital in Mount Pleasant, Westmoreland County.

Even before the federal health care overhaul legislation passed in 2010, “We knew there were things coming up in the budget that were going to affect reimbursements for readmissions,” said Mr. VanSickles, who is also a registered nurse.

After an early collaboration with Highmark’s Quality Blue program, Grove City put together a program to reduce readmissions.

Among the initiatives:

• Each patient has a “transition nurse” who calls the patient at home to make sure that individual understands the discharge instructions, which medications to take and when, and make sure a follow-up visit is scheduled with the primary care physician.

• A telephone “Care Line” is available to answer patient questions around the clock.

• A “Home with Meds” program provides patients with a one-month supply of medications at discharge, with their local pharmacist following up. The medication is packaged in a special dispenser, marking what pill should be taken at which time of day.

The “Home with Meds” program is more than just a convenience, said Mr. VanSickles. Patients are sometimes discharged in the evening, after their local pharmacy is closed, so patients could miss their critical first doses. “It’s more to help the patient get a solid footing on their treatment program,” he said.

• In a few cases involving chronic conditions, the hospital will arrange to put equipment in the patient’s home so vital signs can be monitored. “We do that to help teach the patient how to manage their illness at home. The hospital is not always the right place for them. Our goal is to help patients be as independent as possible for as long as possible.”

The hospital also set up a coumadin clinic for patients using the strong anticoagulant for preventing blood clots. Because coumadin also can increase the risk of bleeding, careful monitoring is critical. Now, instead of a blood draw that gets sent to a lab, a simple finger stick provides results in 10 minutes.

The coumadin clinic required a $20,000 outlay for the technology and equipment, and the hospital rents the telemonitoring equipment for $25 a day for each patient, said hospital spokeswoman JoAnne Clobus, while the other initiatives are incorporated into existing staff time.

Every month, Grove City invites representatives from local nursing homes and assisted living facilities, pharmacists and EMS staff, as well as the Area Agency on Aging, to meet and discuss ways to improve care for area residents, including preventing unnecessary readmissions.

It’s a big group some months, sometimes more than 50 people, said Mr. VanSickles, but ultimately the collective goal is personalizing care for each patient.

“Not every patient fits a checklist,” he said. “We have to adjust that checklist to that individual and we try very hard to do that.”

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