WASHINGTON – A Medicare penalty for too many patient readmissions has led physicians and hospitals to adopt new strategies that prevent returns to the emergency department.
Fines of $227 million will be levied against 2,225 hospitals during the 2014 fiscal year that began Oct. 1. About 1,300 other hospitals will avoid penalties.
NCH Healthcare System in Naples, Fla., is a system with two hospitals that has not been penalized, said Dr. Allen Weiss, president and CEO. The secret to success so far has been use of robust health information technology, standardization of best practices, and identifying those at risk of a readmission.
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Dr. Joel T. Allison (left)
"During the hospitalization we can tell who is most likely to be readmitted," Dr. Weiss said. "It’s not rocket science when you start to identify your high-risk folks. Then you direct attention toward them and drill down on a root-cause analysis."
Typically, the hospital system staff will find a medication error during a reconciliation check. The hospital has addressed this type of problem by providing patients access to a pharmacist before discharge and education about the medicine. The pharmacist will then "teach back" the education by asking the patient about what has been prescribed.
"We also are doing follow-up calls for patient satisfaction, to see if they got their medications and if they have made a follow-up appointment with their primary care physician," Dr. Weiss said. "It sounds easier than it actually is."
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Dr. Allen Weiss (left), Dr. Clifford Ko
Medicare began to penalize hospitals for excessive readmission rates in October 2012. The penalty attempts to incentivize hospitals to lower 30-day readmissions for heart attack, heart failure, and pneumonia. Initially, the move amounted to a maximum of 1% of Medicare pay.
In fiscal year 2014, the penalty rises to 2%, and in 2015 the Medicare agency is expected to add hip and knee surgery and chronic obstructive pulmonary disease to the list of conditions used to measure performance.
Physicians and hospitals face challenges with patients who have multiple chronic conditions and social problems. Safety net hospitals have been hit disproportionately with penalties, panelists said at the Hospital of Tomorrow meeting, which was sponsored by U.S News and World Report.
Hospitals are allocating resources differently to address problems. Baylor Scott & White Health in Texas has helped care for diabetic patients in a poor section of southern Dallas by investing in a fitness center, which includes a demonstration kitchen to teach patients how to cook healthy meals, said Joel Allison, president and CEO of the 43-hospital system. The center also hosts a farm stand to provide fruits and vegetables at a low cost.
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Dr. Clifford Ko (left), Dr. Steve Sternberg (center), and Dr. Allen Weiss (right)
"We’re 85 percent unfunded but we feel like it’s the right thing to do," Mr. Allison said. "It’s helping to improve the health of that community."
Baylor Scott & White Health also will work with patient-centered medical homes to treat individuals who present in the emergency department with a problem that can be treated in a clinic. This avoids the potential problem of the patient waiting a long time in the ED and then being admitted because the issue was not addressed right away.
Good data also are key to preventing readmissions, said Dr. Clifford Ko, a surgeon at UCLA Jonsson Comprehensive Cancer Center in Los Angeles. Dr. Ko is director of the American College of Surgeons National Surgical Quality Improvement Program and Division of Research and Optimal Patient Care.
Readmissions following surgery often are due to complications stemming from the primary procedure, Dr. Ko said. Surgeons can expect more quality measures aimed at reducing readmissions.
"We are going to have less administrative claims measures and probably more registry-based measures," Dr. Ko said.