So picking up from my last post, it seems like decreasing hospital readmissions is an opportunity perfect for the ACO.  Quality can be improved and unnecessary costs lowered.  Everyone would benefit.  You might think that the only possible exception would be the hospitals since decreasing readmissions would decrease their revenue.  Until recently that was the case.  But one of the provisions of the Accountable Care Act has established a financial penalty for hospitals whose readmission rates for Medicare patients with heart failure, heart attack or pneumonia exceeded the national average in the past.  The penalties began in October of 2012 and can decrease a hospital’s reimbursement from Medicare by up to 1% of its charges during 2013.  It is estimated that the penalties will amount to $250 million dollars in 2013.  The maximum percentage penalty will increase to 2% and then 3% in the next two years for hospitals that don’t lower their rate.  So hospitals now also have a strong reason to support programs designed to prevent readmissions.

 Preventing Readmissions

No matter who manages it, a program to prevent readmissions must have some basic components:

• Patient identification – It is critical that the team responsible for the program gets notification of the patient’s discharge as promptly as possible.
• Patient prioritization (if possible) – This can help the team focus on the patients more likely to be readmitted.
• Patient outreach to
  • Schedule an office visit with the patient’s physician to check on their progress.  The patient is also told what symptoms should cause them to contact the physician immediately and not wait until the scheduled appointment since deterioration can sometimes occur very rapidly.
  • Assess needs and make sure components of the discharge plan are being implemented as intended.
  • Medication reconciliation to make sure the patient is taking the right medications.  This includes addressing any problems the patient may have in obtaining the medications.

Who Should Run A Readmission Avoidance Program?

While a hospital can run such a program, they will have to make sure they have adequate staff to manage the care coordination pieces.  Integration with the patient’s physician can also be a problem.  However, a common part of most ACOs is a team of clinical staff, usually nurses, who work with the patients’ physicians to coordinate their care.  This team is focused on the needs of the physicians’ patients so it is natural for them to play the role of reaching out to the discharged patient to assess and address their needs.  So, an ACO seems to have an advantage in conducting a readmission avoidance program.  Their only critical need is getting real-time notification of the patient’s discharge.  Thanks to the recent Medicare penalties for readmissions, hospitals have an incentive to get the ACO prompt discharge information so the ACO can reach out to the patient.

In the next post I’ll provide more details about how these program components can be put into operation in different communities.

For Your Health – Dr. Bob