1 in 5 Medicare patients return to the hospital within a month of being discharged, costing program $17 billion annually.
WASHINGTON — Care doesn’t end when a heart attack patient is released from Bloomington Hospital.
A case manager calls within 48 hours to see if the patient has been able to fill prescriptions, has had trouble taking them and has made a follow-up doctor appointment.
Interactive: Compare hospitals on heart attack, heart failure and pneumonia
The hospital has a scholarship program so patients can afford to learn and make lifestyle changes to prevent another heart attack.
And the treatment the patient received in the hospital is reviewed within a month by doctors, pharmacists, lab specialists and a quality-control team to see if there are any lessons to be learned for the next patient.
Those might be some of the reasons Bloomington Hospital does better than most in the country at making sure heart attack patients aren’t readmitted within 30 days.
“I feel good,” said Jewell Reuter, Springville, who has been using the hospital’s cardiac rehabilitation program since having a stent placed in a coronary artery about two months ago.
She’s even been lifting weights. “I started with 3 pounds, and now I’m up to 10 pounds,” said Reuter, 77.
Only 11 hospitals in the U.S. have a lower readmission rate for heart attack patients than Bloomington Hospital, according to a Medicare review of 4,400 hospitals’ records from 2005 to 2008. Clarian Health Partners of Indianapolis was close behind, with the 21st-best rate in the country.
Other Indiana hospitals, including Ball Memorial Hospital in Muncie and St. Vincent Heart Center in Indianapolis, ranked among the top 25 in the country in readmission rates for treating either heart failure or pneumonia.
Money-saving measure
The federal government thinks that if more hospitals are like those facilities, patient care would improve and taxpayer money would be saved.
One in five Medicare patients returns to the hospital within a month of being discharged, according to the Centers for Medicare and Medicaid Services, which released hospitals’ readmission rates this summer.
“The president and Congress have both identified the reduction of readmissions as a target area for health reform,” said Health and Human Services Secretary Kathleen Sebelius. “When we reduce readmissions, we improve the quality of care patients receive and cut health-care costs.”
Barry Straube, chief of clinical standards and quality at the Centers for Medicare and Medicaid Services, said heart attack, heart failure and pneumonia patients shuttling back and forth to hospitals account for 46 percent of hospital admissions and cost Medicare roughly $17 billion a year.
The health-care overhaul bills moving through Congress would reduce Medicare payments to hospitals with high readmission rates. That could affect hospitals such as St. Catherine Hospital in East Chicago.
St. Catherine is the only hospital in Indiana with a readmission rate for pneumonia that is higher than the national average. It is one of two Indiana hospitals with readmission rates for heart failure higher than the national average.
A hospital spokeswoman said its congestive heart failure program has received top ratings for the past seven years from HealthGrades, an independent ratings group. In fact, the Medicare ratings also show that a smaller percentage of heart failure patients die at St. Catherine than the national average for those patients.
Hospital officials said St. Catherine’s higher readmission rate could be related to the population it serves. It’s the only hospital in East Chicago, a highly industrialized area with steel mills and oil refineries that can be hard on health.
Ready to make changes
The hospital industry has agreed to the readmission reimbursement penalty as part of its commitment to accept $155 billion in cuts over the next decade — its share of the cost of providing health coverage to more Americans.
“We do know that there are instances when there are avoidable hospital readmissions that cost Medicare dollars, and we are committed to improving upon that,” said Maulik S. Joshi, vice president for research for the American Hospital Association.
Vickie Franck, executive director of Bloomington Hospital’s Regional Heart and Vascular Institute, said the hospital was trying to improve cardiac care in general — not specifically to improve readmission rates — when it tackled cardiac treatments.
The hospital focused on improving identification of heart attack patients who don’t have the typical symptoms. It also streamlined its cardiac care with the Emergency Medical Systems in the region so EKG results are transmitted directly from the field, letting the hospital get the patient to the cardiac catheterization lab faster.
For follow-up care, the hospital stepped up its coordination with area nursing homes and home-care agencies.
“They’re highly motivated. We’re highly motivated,” said Kathy Bennett, director of case management for the hospital. “So we’re talking about how, as a group, instead of being in our silos, we can work together to prevent readmissions.”
Follow-up care is important because, for example, patients might not know what to do if a pharmacist says they need preauthorization from their insurance company to fill their prescriptions. Or they might stop taking their prescriptions, for financial or other reasons, when they start to feel better.
Reuter said she was surprised to get the follow-up call from Bloomington Hospital.
“I figured when I left the hospital that I was OK, or they wouldn’t have turned me loose,” she said. But she praised the hospital’s efforts to help keep her on track on diet changes and exercising. “They say they’ve never had anyone do it like I do. I’m a farm girl,” Reuter said. “I’m probably ahead of most of them in terms of how much weight (I lift) and how I exercise. I wanted to get the most out of it and to help me as much as I could.”
Bennett said hospitals can help, but patients also must take responsibility. “As long as we give the patient the choice of being compliant and choosing the way they want to live,” Bennett said, “I don’t think the hospital can be held responsible for making sure no readmissions occur within 30 days.”
Source Indystar.com October 9, 2009
