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Medicare's Revolving Door? Ways Sought to Cut Readmission Rates

June 22, 2009
Friday, June 12, 2009 | Modified: Saturday, June 13, 2009 Medicare’s revolving door?Ways sought to cut re-admission rates Denver Business Journal - by Bob Mook Kathleen Lavine | Business Journal Dr. Jane Brock, chief medical officer for the Transitions Support Center at the Colorado Foundation for Medical Care, outside the Wheat Ridge Recreation Center, the site of a community meeting on June 29. The meeting will launch a program that encourages a smooth transition for elderly patients to prevent re-admission into hospitals. View Larger Medical professionals are examining new ways to keep sick people from returning to local hospitals shortly after they’ve been discharged — a problem that costs the federal Medicare program billions of dollars a year and contributes to the rising costs of health care. The Colorado Foundation for Medical Care is spearheading a project in northwest Denver to improve the quality of care for Medicare beneficiaries before and after patients are discharged. The goal is to prevent patients having to return for treatment of the same illness. “There are many things hospitals can do to ensure patients aren’t re-admitted,” said Dr. Jane Brock, chief medical officer for the Transitions Support Center at the Colorado Foundation for Medical Care. “But more support [from doctors, nursing centers, etc.] helps. Hospitals say they can’t control all their re-admissions and some doctors admit it takes a community effort.” Brock is one of the health care leaders behind the Northwest Care Transitions project. It’s designed to encourage medical and community organizations, employers, policymakers, nursing centers and patients to find ways to make care for older patients with chronic illnesses more effective and efficient. The project, funded by the federal Centers for Medicare and Medicaid (CMS), aims to reduce re-admission rates by ensuring that seniors get appropriate follow-up care after they leave the hospital. Participants include Lutheran Medical Center, St. Anthony’s Central Hospital and Physician Health Partners, a Denver-based doctors’ group. The effort comes as Congress considers new regulations that crack down on avoidable re-admissions and incrementally cuts Medicare payments for hospitals that dismiss patients too quickly. The Senate Finance Committee is proposing changes in Medicare payments to hospitals that, starting in 2013, would withhold hospital payments for eight avoidable re-admissions conditions, including congestive heart failure and pneumonia. The American Hospital Association (AHA) is resisting the proposal, saying many re-admissions are beyond the control of hospitals. The association worries the policy, if implemented, could further reduce payments from the already underfunded Medicare system, and strain hospital finances. But in a 20-page letter to the Senate Finance Committee, the AHA expressed a willingness to work on the problem, acknowledging that avoidable re-admissions aren’t in the patients’ best interests and are costly to the health care system. Steven Summer, president and CEO of the Colorado Hospital Association, said the debate over re-admissions presents “an opportunity to improve health care,” but cautioned that though they’re a problem, most re-admissions have nothing to do with what happens during a hospital stay. Regardless of what happens to the proposal, sweeping changes in Medicare reimbursements are inevitable because the CMS realizes it’s rewarding bad medical care under the current system, said Debbie Welle-Powell, vice president of payer strategies and legislative affairs at the Denver-based hospital system Exempla Healthcare. “This is not good medicine; it’s rewarding people for bad care,” Welle-Powell said, adding she considers reimbursements the biggest piece in the health care reform puzzle. “When we stop paying for bad care, the system is going to get smart about the way patients are treated.” Welle-Powell said Exempla’s Lutheran Medical Center has reduced the percentage of Medicare re-admissions within a 30-day period from 11.8 percent in 2007 to 10.7 percent in 2008. She said it did so by evaluating data from medical claims and revamping its discharge policies. If hospitals have been slow to tackle the problem, it’s because there have been few incentives to avoid readmissions, Brock said. “Hospitals make a lot of money on re-admissions and never had motivations to solve problem in the past,” she said. She said one key to solving the problem is getting doctors and hospital administrators to analyze claims data and agree on the best practices for patients. Northwest Denver Care Transitions will take that approach in the next six months. “There’s been a long-standing tension between physicians and hospitals,” Brock said. Dr. Jay Want, president and CEO of Physician Health Partners, agreed that communication between doctors and hospitals is the “elephant on the table” in the debate over re-admissions. But he said the proposed reforms may benefit patients and save money — though they might result in longer hospital stays. National data indicate that many hospitals might be dismissing patients too soon and costing the system more in the long run, Want said. But he added that Colorado medical professionals have a good head start in solving the problem. “We have good leadership in Colorado and we’re blessed with a good hospital association,” Want said. Last month, U.S. Sen. Michael Bennet, D-Colo., introduced a bill that would create a nationwide network of community-based transitional care coaches. Their role would be to improve patient quality and cost-effectiveness of care for Medicare beneficiaries, which would help providers to reduce hospital re-admission rates. Bennet said Colorado has been a leader in developing transitional care programs to lower re-hospitalization rates. He cited an effort from Rocky Mountain Health Plans on the Western Slope, which leads the nation with a 3 percent re-admissions rate — compared to the national average at 17.6 percent — because of an emphasis on timely follow-up care. Dr. Eric Coleman, a professor of medicine at the University of Colorado, developed a program that encourages a smooth transition for elderly patients to prevent re-admissions. Coleman’s program encourages patients to take a more active role in their health care with tools and skills that are reinforced by a nurse, social worker or trained volunteer. It encourages a primary care provider and patient follow-up and helps patients read signs that indicate deteriorating health. Coleman’s approach cut per-patient hospital costs by about $300,000 per 350 patients, according to a 2007 study from the California Health Care Foundation The Northwest Care Transitions project will host a launch event on June 29 at the Wheat Ridge Parks and Recreation Center, 4005 Kipling St. The event features Coleman as a keynote speaker. Registration is available at www.cfmc.org/ctregister.