Getting proactive on hospital readmissions

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Ben Adkins
Ben Adkins
Hospital readmissions have been a hot topic during the past two years as the federal government attempts to stem skyrocketing healthcare costs through improved patient care.

Hospitals have a particularly timely interest in cutting readmissions. As part of last year's healthcare reform legislation, beginning in October 2012, the Centers for Medicare & Medicaid Services will begin to levy penalties on hospitals for patients who are readmitted within 30 days of being discharged.

But long-term care providers also have plenty at stake as it relates specifically to hospital readmissions, and working to reduce them. And, as debt ceiling talks and federal budget woes raise the specter of additional cuts to programs such as Medicare and Medicaid, it behooves LTC providers to seek creative solutions to curb healthcare spending and retain revenue.

According to a study conducted the by the Medicare Payment Advisory Commission, or MedPAC, an independent Congressional agency established to advise U.S. Congress on issues affecting the nation's Medicare program, nearly 20% of Medicare beneficiaries who are discharged from a hospital are readmitted within 30 days. The study, published in the New England Journal of Medicine, also found that 34% of patients are readmitted within 90 days and 56% are readmitted within a year.

MedPAC also found that hospital readmissions cost Medicare $15 billion in 2005 — an estimated $12 billion of which was potentially preventable.

President Barack Obama's budget for fiscal year 2010 also included measures to reduce hospital readmissions. The budget indicated that Medicare would save about $26 billion over a 10-year period through improved care after hospital stays — hence, the provision in the reform legislation to reduce readmissions.

To address the matter, Signature HealthCARE, which operates 73 long-term care facilities in seven states, this year launched a pilot program dubbed TransitionalCARE. The program more closely monitors patients at risk for readmissions and eases patient transitions between care settings. The process began about 20 months ago, focusing on transitions between the hospital and nursing facilities, as well as transitions from the nursing facilities to home.

“This program has allowed us to partner with hospitals for a shared commitment to improve the continuum of care, which has shown to reduce hospital readmissions,” said Kara Plaks, Business Development Leader for Signature's Post Acute division, who helped spearhead the project.

Signature's foray into the topic of hospital readmissions revolved largely around improving the customer experience. But added benefits of reduced hospital readmissions include less risk of infection and fewer complications, along with improved census.

The program centered on Signature's post-acute buildings in part because they have the highest volume of transitions between settings.

Plaks and other members of the post-acute team, as well as key clinical leaders including Chief Medical Officer Dr. Dennis Stone, Chief Nursing Officer Cleo Boulter and Care Consultant Debra Havranek, developed the program based on existing evidenced-based models, and their own research and feedback from healthcare providers. The program calls for increased clinical focus on patients at risk for readmissions in order to more quickly identify and manage changes in the conditions of these at-risk patients.

Early identification of a patient's health issues lessens the likelihood that he or she will have to return to the hospital. There is also a focus on medication reconciliation and using transitional coaches to teach patients to take care of their own health.

The program was rolled out in March to eight Signature buildings and already has yielded demonstrable results. For instance, Signature HealthCARE at Saint Francis, in Memphis, TN, has seen the number of patients readmitted to hospitals within 30 days shrink from 28% to 13% since March. Overall, hospitalizations were cut by half during the three-month period.

“We have three transitional coaches who provide six coaching sessions during the patient's stay,” said Reneé Tutor, the facility's administrator. “Patients are an important part of developing their Personal Health Record so they may understand their diagnosis, medications and any red flags, allowing for greater management of their own health.”

Signature's next step is to apply for a CMS grant that would help underwrite the cost of dedicating medical professionals to the effort to reduce readmissions. For that, Signature has enlisted the help of the nonprofit Signature Research Institute (SRI) and is in discussions with the University of Kentucky about partnering on the project.

SRI is in discussions with researchers at UK's Center for Gerontology and College of Public Health about helping write the CMS grant and measure the Signature program. Meanwhile, a Ph.D. student at UK is helping apply “lean” principles to the program, in order to make it more efficient and effective.

CMS began accepting applications and enrolling participants in April for the grant program, which will run for five years. The program could be expanded or extended beyond the five years if it demonstrates financial sustainability by reducing Medicare expenditures without reducing quality. For more information on the CMS grant, click here.

Ben Adkins is the media relations manager at Signature HealthCARE.

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