BHS reduces rate of readmissions
A hospital visit often is the breaking point following a long road of deteriorating health. But that road doesn't end after the patient is discharged.
“It's all part of this program where we have folks who are supporting patients not just inside the building, but also once they leave,” said Dr. Elliot Smith, chief clinical officer and an internal medicine specialist with Butler Memorial Hospital. “We're holding ourselves accountable when people leave the building. A lot of organizations are falling a bit flat by not staying attentive and making sure patients get their meds, have picked them up.”
This effort is a response to an Obama-era federal government program that financially punishes hospitals that have high rates of Medicare patients being readmitted within 30 days of being discharged.
The Hospital Readmissions Reduction Program is part of the Affordable Care Act and imposes financial penalties on hospitals with above-average readmission rates for six types of patients: those initially admitted for heart failure, pneumonia, acute myocardial infarction, chronic obstructive pulmonary disease, coronary artery bypass graft surgery or elective primary total hip arthroplasty and/or total knee arthroplasty.
The rules were finalized in 2011 and 2012, and then implemented in October 2012. The federal Centers for Medicare & Medicaid Services assess a hospital's performance relative to other hospitals with a similar number of patients who are eligible for Medicare and full-benefit Medicaid beginning in fiscal year 2019.
For the readmission penalties, Medicare reduces payments to hospitals with excessive readmissions. Butler Memorial Hospital reached its highest reduction with .24 percent in 2016 and the penalty has since dropped. Last year, the hospital didn't face any penalties.
But one oversight of the federal program is that a patient's reason for being readmitted to a hospital isn't considered in their calculations. Smith said this means that if someone was treated for pneumonia, but is readmitted for a broken leg within 30 days, that patient is considered a readmittance.
Between 2014 and 2017, the hospital saw 127 readmissions, according to government collected data. Butler Hospital's successful decline in readmission could become more complicated once it merges with Clarion Healthcare System.
Clarion Hospital saw its highest reduction in Medicare funds in 2015 with a .63 percent hit, but this year the penalties have already passed that record with a .66 percent reduction. In August, Butler Health System and Clarion Healthcare System announced that a merger between the two was close to being completed. Once finalized, Clarion Healthcare System will be integrated into Butler Health System.Butler Memorial Hospital is a 326-bed acute care facility, compared to Clarion Hospital's 70-bed community hospital.Smith was confident they would be able to take the lessons that helped them reduce readmissions and apply them to their new acquisition.“As a health system, we knock it out of the park,” Smith said. “We embraced this idea of value-based care. We think it's important that patients receive the right care at the right place at an appropriate price.”Smith said policies such as requiring a patient to see a primary care provider within five days of being discharged and having nurses guide patients help the hospital keep readmission rates low.And the need for that kind of extended care is so important, Smith said, that they have created the Population Health Team, a group of doctors, nurses and other medical staff devoted to a patient's care after being discharged.“Some hospitals, people will spend a week and then go home where there's no fresh food, no medicine and they can't take care of themselves and end up back in the hospital,” Smith said.The readmissions reduction program was created in response to high rates of admission of Medicare patients, according to Peter Orszag, the director of the Office of Management and Budget under President Barack Obama. Before the program, hospitals were paid every time a patient came back to a hospital and Orszag saw that as a hospital being rewarded for having a high rate of readmissions.
