Hospitals want patients to recover, not return

| Saturday, March 30, 2013, 12:26 a.m.

Faced with the possibility of federal fines, Alle-Kiski Valley hospitals are taking varied approaches to make sure patient readmissions are low.

Hospital readmissions are a nationwide problem. In fact, a provision in the Affordable Health Care Act allows the federal government to levy fines, or reduce Medicare payments, to hospitals with high readmission rates.

The country's average readmission rate fell to 13 percent in 2012, according to the Centers for Medicare and Medicaid Services. That was down from 17 percent the previous five years.

Medicare payments to Allegheny Valley Hospital in Harrison were reduced by 1 percent last year because the hospital's readmissions — nearly 19 percent — were too high.

That's the highest Medicare payment reduction rate for a hospital in Western Pennsylvania and the maximum penalty the Centers for Medicare and Medicaid Services will impose.

In response to the sanctions, for the last year Allegheny Valley Hospital has employed a team whose lone goal is to make sure high-risk patients stay on the track to recovery once they leave the hospital.

So far, the team — which is made up of a doctor, case manager, emergency department nurse, psychiatric nurse and social worker — has led to statistical improvement.

In the team's first year, 30-day readmissions have fallen by 2.5 percentage points, from 18.9 percent to 16.36 percent, according to hospital spokeswoman Linda Dalak.

Dalak said AVH's readmission team works to make sure patients know that recovery doesn't end when they leave the hospital grounds.

“A lot of times, patients don't remember what they're supposed to do,” she said. “When you have someone continuing to follow up on the patient's care, you get a better outcome.

“Sometimes, patients don't have transportation to continue their care plan,” she added. “This team has been very successful because they do many things to help a family and the patient.”

Like Allegheny Valley, UPMC St. Margaret hospital in Aspinwall had its Medicare payments cut in 2012, but only by 0.15 percent.

Since last spring, St. Margaret's has reduced readmissions from 13 percent to 7 percent, according to Marjorie Jacobs, the hospital's director of care management and quality.

“We're tackling it from a lot of different ways,” Jacobs said. “We're targeting, in particular, high-risk patients with conditions such as chronic pulmonary disease.

“We've standardized the care that they received. ... What we ultimately did is, we have a nurse that goes into the patient's home after discharge and we follow up with them weekly,” she said. “We've been very successful with that project.”

Jacobs said St. Margaret's has reached out to local nursing homes and rehabilitation facilities to make sure the standard of care continues to be maintained.

“We have worked with five skilled facilities in the area,” she said. “We have found with all of those facilities, we've reduced readmissions from 12 percent to 20 percent.”

The gold standard for readmissions in the region is ACMH Hospital in East Franklin.

ACMH was one of two area hospitals not to have Medicare payments cut because of high readmissions in 2012, according to the Centers for Medicare and Medicaid Services.

“Our current readmission rate for seven days is 4.03 (percent), so we're pretty low, and our 30-day is 12.5 percent,” said Joyce Wright, executive director of operational excellence at ACMH.

Wright said her hospital's success can be pinpointed to many things, but not just one or two particular programs.

“I wish we could say we've identified a couple proven things,” she said. “You can't leave any stone unturned.

“We make sure we have good patient education on the condition that brought them patient into the hospital,” she said. “We're working on making sure patients discharged with high-risk diagnoses are seen within seven days of discharge by a personal care provider.

R.A. Monti is a freelance writer for Trib Total Media.

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