Hospitals Scramble To Limit Readmissions Under ACA
|By John Murawski, The News & Observer (Raleigh, N.C.)|
The Clayton grandmother, weakened by a failing heart and obstructed lungs, wasn't home even two weeks after the first hospital stay before returning to
To ease the financial sting, hospitals increasingly are trying to manage patients' health care after they are discharged. Hospital personnel make follow-up calls, schedule doctors' visits and set up therapy appointments.
Hospital administrators say the pressure to reduce readmissions is forcing them to take steps that are long overdue -- by coordinating with nursing homes and family caretakers to treat health problems early, before they blow up into emergencies.
King saw a difference at Wake-Med on her return visit.
"This time when I came back in, it was more focused, it seemed to me," King said from her
The penalties in the federal health care law are designed to reduce unnecessary costs and curb waste. Chronically ill, elderly patients, typically on fixed incomes, are among the costliest in the system; some rotate in and out of emergency rooms as a way of dealing with poor health.
But industry advocates warn of a potential downside: Struggling hospitals, spooked by the prospect of huge penalties, could develop an unhealthy fixation on finding ways not to readmit patients who need hospital care.
Already hospitals nationwide have seen an uptick in patients being steered to observation beds rather than getting admitted, Foster said. Hospitals in economically distressed areas with limited health care options are most likely to readmit patients and pay penalties for doing so, she said.
"It's hard to think there will be a financial penalty against your organization to do the right thing by your patient." Foster said. "We don't think that hospitals that serve impoverished, safety-net communities should be penalized because those communities lack the necessary resources."
Readmissions are only one of several factors the federal government is tracking to reduce the cost of health care. All told, within several years hospitals could face up to an 8 percent reduction in
Insurance companies are likely to adopt similar measures, based on the model developed by
The fines apply for readmitting too many patients with at least one of three conditions -- heart failure, heart attack or pneumonia -- within 30 days of discharge.
A readmission can be for any cause -- usually not the fault of the hospital. A pneumonia patient who leaves
Each hospital is allotted a certain number of readmissions, based on a complex formula that factors in fluke scenarios like auto accidents, slips-and-falls and others unrelated to heart conditions or pneumonia.
Patients often go back into a hospital because they have trouble following directions for their medications. During a hospital stay and while recuperating, patients can be disoriented and confused, making it hard to keep track of multiple medications.
Heart patients, for example, are urged to adhere to a low sodium diet, but not all comply. "We had one patient who was taking their pills with pickle juice," said
Still, a number of
In the Triangle,
Owens noted that the penalty patterns in the Triangle reflect the type of patient each hospital treats. Duke hospital draws heart-transplant and lung-transplant patients from a broad region, and the
"We get heart attack patients from all over
Owens noted that the measures Duke uses to prevent readmission are "a fraction of the cost of coming in the hospital."
Among the steps taken by the Duke system: equipping outpatient clinics with IV medications, infusions and monitoring technology previously available only at the hospital.
Rex runs a readmission prevention clinic two days a week where dietitians, clinical nurses and pharmacists coach recently discharged patients on staying healthy. Rex's
Through various strategies,
"It's basically sharing information which in the past has never been shared," said
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