Wednesday, January 8, 2014
Columbia, SC — The first question many people ask when discharged from a hospital stay: “Now what?” The second question, equally crucial: “How can I reduce my risk of being readmitted?”
So now the third question: “Are hospitals in South Carolina adequately prepared to meet this challenge?” In many cases, the answer is, “We’re getting there, but we all have a lot of work to do.”
Too often, patients are readmitted within 30 days of discharge. Medicare imposes a fine on hospitals that fail to meet 30-day readmission-rate targets for heart attack, heart failure and pneumonia. That potential penalty recently doubled from 1 percent to 2 percent and will reach 3 percent Oct. 1.
As a result, 34 of 57 S.C. hospitals — 60 percent — incurred a federal penalty in 2013. That cost those hospitals and our communities $3.3 million in withheld reimbursements.
Many readmissions, or bounce-backs, are avoidable, and some hospitals already are on track to go unpenalized. Our own nationwide survey found the No. 1 strategy that hospitals adopt to lower preventable readmissions is to partner with post-acute-care specialists who deliver health care at home. However, only 40 percent of hospitals surveyed have found the right home-health-care partner. Surprisingly, 18 percent have no plans to team up with a home-health provider, while 8 percent have yet to decide about choosing one at all.
One key here is a metric called acute hospitalization rate, which is the percentage of patients admitted to a hospital within 60 days of starting home health. The lower a home-health provider drives the acute hospitalization rate, the more likely a hospital will be to lower its readmission rates — and the better its prospects for avoiding the Medicare penalty.
I practice family medicine in South Carolina and regularly care for my hospitalized patients. So I have a clear-cut idea about how this should work. I’m also the regional medical director for the largest home-care provider in our state, serving 28,000 S.C. patients in 2012.
Georgetown Hospital System, which includes Georgetown Memorial Hospital and Waccamaw Community Hospital, has partnered with our home-care provider and, as a result, expects to continue reducing readmission rates for the three major conditions measured by the federal government. In fact, the Carolinas Center for Medical Excellence found that Waccamaw Community Hospital had the largest readmission penalty reduction in the state in 2012.
What else needs to be done? For starters, discharge practices for acute-care patients must be fine-tuned. Patients with chronic conditions must receive preventive care and be monitored. Hospital discharge should be coordinated with physician follow-up.
The patients at highest risk should be assigned the highest priority. Hospitals always should take advantage of the programs available to ease the transition to home care. If patients do wind up readmitted, case managers and clinicians should confer to determine what could have prevented it.
The broader solution is for hospitals to forge connections with all the key participants in the health-care system. Nobody can work alone anymore — or should. Communication, coordination and collaboration with primary-care physicians, nurses, social workers, therapists, nursing homes, assisted-living facilities and, of course, the community should be ongoing.
The readmissions issue is all the more urgent in South Carolina, which ranked 46th in overall health in the country in 2012, down from 45th the year before.
Ultimately, lowering readmissions benefits everyone — patients, providers and, yes, the federal government. It’s good for our economy and a big step in our effort to reduce the cost of health care. But more importantly, it’s good for our health.
This column first appeared in The State newspaper in Columbia. Dr. Harmon lives in Pawleys Island. He is regional director for Amedisys Home Healthcare; contact him at email@example.com.