OVMC Hosts Readmission Coalition Fair

Program aimed at reducing avoidable hospital readmissions and improving patient care.

Monday, September 21, 2015

 

The Affordable Care Act requires Medicare (CMS) to reduce payments to hospitals participating in the Medicare program with excess readmissions, effective for discharges beginning on October 1st of 2012.  Although the rule has been modified in subsequent years, CMS continues to monitor readmissions and penalize hospitals who exceed the allowable percentage.

OVMC has worked closely with the Readmission Coalition, which consists of healthcare providers in the Northern Panhandle of WV and several counties in Ohio, to educate our community providers about this ruling and how to provide better patient care while reducing avoidable readmissions that could prove costly to hospitals.  The education program includes discussing the financial impact readmission could have on healthcare costs.  For example, the average cost of one avoidable hospital readmission could be $9,732.  With 20% of discharged Medicare patients in the US being readmitted to a hospital within 30 days would be nearly 2.3 million Medicare beneficiaries and $22 Billion in one year!  The cost is significant and could have a negative impact on the cost of healthcare in general.

At this time, there are specific diagnosis that are tracked by CMS for readmission statistics.  Those include Congestive Heart Failure, Stroke, Pneumonia, Acute Myocardial Infarction, Heart Failure, Total Hip Arthroplasty and Total Knee Arthroplasty. This means that if you are hospitalized for any of the monitored diagnosis and within 30 days of discharge you are readmitted with a different diagnosis, the readmission is coded for the original hospitalization diagnosis.  There is also the “all-cause” indicator.   If you are admitted for a diagnosis that is not being tracked and subsequently are readmitted within 30 days of discharge, this too, would fall under the “all-cause” indicator.  CMS is expected to add additional diagnosis to be tracked in 2016.

So how do hospitals and healthcare workers reduce avoidable readmissions?  According to Staci Trudo, Chief Quality Officer for OVMC, “Keeping patient care at the center of what we do, we need to look at the most appropriate discharge for the patient to allow for continued recovery without the need for readmission to a hospital.”  She continued, “That could include home health, skilled nursing and rehabilitation, hospice, nursing home or a combination of extended services.  There are multiple indicators for each level of care needed”

Among the 32 participating healthcare service providers were skilled nursing facilities, Long Term Care Acute nursing facilities, acute rehab, home health, home infusion, private pay services, durable medical equipment providers and hospice.  More than 100 attendees included physicians, nurses, physician office staff and other healthcare professionals.

This coalition was formed to bring all local healthcare organizations together to have a better understanding of what is available in our community and how to best utilize services to provide the best patient care experience from beginning to end of a person’s healthcare needs.  The group consists of many competitors who have removed the barriers and are working together to improve patient outcomes through better management and coordination of care at the time of discharge.  Nancy Heaton, RN with the Performance Improvement Team at OVMC/EORH, says “I’ve never seen a group of competing organizations come together in one place and work as a team in this way.  These organizations who provide care at various levels know that the “trickle down” effect of reduced payment will impact them as well as the hospitals.  We have all decided to put the financial aspect on the back burner and concentrate on what is best for our patients and our community.  By working together to ensure an appropriate discharge for the patient’s well-being, we are ensuring better outcomes for everyone.”

OVMC and EORH are proud to be involved with the Readmission Coalition and are committed to working hand in hand with these providers to improve readmissions and ultimately patient outcomes.