Feds zero in on costly readmissions

At South Georgia Medical Center in Valdosta, front-desk clerk Frances Blanton, 72, sees countless people bounce back and forth between hospital and home.

This is a high-traffic hospital, one of two in a county with nearly 115,000 people, but similar patterns can be seen in any hospital.

“We have a lot of frequent flyers in and out of here,” Blanton says.

Her responsibilities include keeping track of who is hospitalized on any given day, and she says some of the repeat admissions involve people who clog the emergency room as well.

“People do not see their doctor first, they just come into the ER,’’ she says. “This causes an overflow of patients.”

The repeat ER visits interfere with the hospital’s functioning and hurt the bottom line.

The federal government hopes to put an end to this “frequent flyer” problem through the new system of rewarding hospitals for quality care and penalizing them for readmissions.

Hospital readmissions cost Medicare close to $26 billion a year. Almost 25 percent of heart failure patients on Medicare, for example, are readmitted to the hospital within 30 days of discharge.

Overall, one in five Medicare patients returns to the hospital within 30 days of being discharged.

Carrot-and-stick approach

Officials with the Centers for Medicare and Medicaid Services (CMS) say readmissions could often be avoided if hospitals and health care providers altered how they prepare patients who are heading home.

“This is the kind of behavior which really doesn’t cost anything but pays really big,” said Mike Fierberg, a spokesman for CMS.

When the Affordable Care Act is fully implemented in 2014, it will reward not only hospitals – but also physicians – for improving the quality of patient care and for avoiding needless readmissions and other excess costs.

After coming home, some patients develop infections or other complications that make returning to the hospital the safest alternative.

But many other readmissions are not medically justified and could be avoided, Fierberg said. Simple preventive steps include:

* Better, more thorough pre-discharge counseling from health care providers.

* Better coordination between patients and providers they’ll rely on in the community, including their primary care physicians.

* Ensuring that patients have an ample supply of necessary medications and know how to take them.

* Making sure patients understand recovery or rehabilitation instructions.

The U.S. Department of Health and Human Services (HHS) will have to convene expert panels and define what constitutes high-quality, high-value care. These goals will be used to set up a grading scale, enabling CMS to issue an annual report card for hospitals and physicians, said Jordan VanLare in his 2012 article in the Journal of the American Medical Association.

This will be phased in over the next several years, and reducing unnecessary hospital readmissions is one of the goals of the new performance monitoring and reimbursement system.

Efficiency vs. compassion?

A total of 2,217 hospitals, or 71 percent of those eligible, are receiving penalties for having too many patients with heart attacks, heart failure or pneumonia return within 30 days, Kaiser Health News reported in October. They include South Georgia Medical Center.

From her vantage point in the Lowndes County facility, Blanton hopes that the new approach will have the intended effect, but she sometimes worries about unintended consequences.

Even though CMS says the ultimate goal is to improve individual care for everyone, Blanton – speaking as an older adult – worries that people in her age group will lose personalized care as Medicare strives to save money and reduce volume.

“I don’t want to be pushed out to sea on an iceberg” when no longer considered useful, Blanton said. “I just hope the government sticks to its promises.”

VanLare, on the other hand, believes that care will become more individualized, not less.

“I can find the innovative parts that are going to be most effective for my patients in my health system; high quality care is not just about following the process measures that come from a large consensus organization.”

“If measures are created that look at outcomes,” VanLare says, “doctors as well as hospitals can take a step back and ask themselves why their patients are being admitted and readmitted to hospitals when they shouldn’t be.”

The New York Times has reported that increasingly, health policy experts and hospital executives say the readmission penalties unfairly target hospitals that treat the sickest patients or the patients facing the greatest socioeconomic challenges.

Still, a recent study shows that hospitals can indeed improve on readmissions.

Fourteen communities in a national care improvement project — including an area in suburban Atlanta — saw a significant decrease in Medicare patients who were rehospitalized within 30 days of a discharge.

The Medicare readmission rate for an area served by Gwinnett Medical Center in Lawrenceville, Eastside Medical Center in Snellville, Rockdale Medical Center in Conyers and Newton Medical Center in Covington fell by 7.5 percent during the two-year program. This area — designated a community for purposes of the project — is east of the city of Atlanta. (Here’s a GHN story on the improvement project)

Overall, Medicare hospitalizations in that area fell by 7.37 percent.

The group of 14 communities nationally reduced readmissions by 5.7 percent over a two-year period, versus a 2 percent drop in a control group.

The study was published recently in the Journal of the American Medical Association.

Katie Ball is currently pursuing a master’s degree in health and medical journalism from the University of Georgia. Her reporting interests include research in medical technology and ustainable environmental practices.