Hospitals, Policy

Minnesota hospital says pilot program cuts costly readmissions

Minnesota has a well-earned reputation for pioneering healthcare reform. So it's not surprising to see this study from Fairview Southdale Hospital. Working with UCare and Fairview Physician Associates, the hospital said it cut patient re-admissions by at least 30 percent over a nine month period.

Minnesota has a well-earned reputation for pioneering healthcare reform. So it’s not surprising to see this study from Fairview Southdale Hospital.

Working with UCare and Fairview Physician Associates (FPA), the hospital said it cut patient re-admissions by at least 30 percent over a nine month period.

From February to September 2010, only 27  of 292 elderly Medicare patients, many suffering from diabetes and heart disease, were readmitted to the hospital within 30 days of discharge. Fairview Southdale’s 9.25 percent readmission rate compares to a 16.5 percent rate during the same period last year.

Experts say preventable hospital re-admissions are a major reason for ballooning healthcare costs in the United States. About 20 percent of Medicare patients return to the hospital within a month of discharge. To fix the problem, the recently passed federal healthcare reform law provides $500 million over five years to manage care for 30 days after hospital discharge and also imposes financial penalties on hospitals with high readmission rates for certain diseases.

Dr. William Nersesian, FPA’s chief medical officer and author of the study, said providers can prevent most hospital re-admissions with simple fixes. For example, a diabetic patient suffering from shortness of breath and heart failure-related weight gain can find himself back in the hospital because he may not have family members to help him take medications correctly, eat the right foods and weigh himself to check for fluid retention.

However, the execution of those fixes can be tricky, Dr. Nersesian said. The pilot project required FPA nurse case managers, hospital social workers and pharmacists to coordinate efforts to manage patients’ care once they left the hospital.

“Getting all of the parties to work together in an optimal way can be challenging,”  Nersesian said.

Another big obstacle: everyone getting paid for their efforts. Medicare typically doesn’t pay providers for ensuring patients properly read the instructions on their pill bottles and buy the rights foods at the grocery store.

Nersesian said there’s an understanding among providers that they would earn less money in the short run for the long-term good. In addition, the FPA’s contract with UCare pays doctors something extra if they meet performance goals, like reducing hospital re-admissions.

That should lessen the sting of doing the right thing.

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