published Tuesday, May 13th, 2014

Care improves: Readmissions are down, as are hospital-acquired ailments

Over the last three years, readmission numbers among Medicare patients fell from 19 percent to 17.5 percent, an analysis released last week by the U.S. Department of Health and Human Services shows.
Over the last three years, readmission numbers among Medicare patients fell from 19 percent to 17.5 percent, an analysis released last week by the U.S. Department of Health and Human Services shows.
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TENNESSEE HIGHLIGHTS

The 63 hospital members of the Tennessee Center for Patient Safety have seen the following results by changing practices “significantly” and reducing patient harm. Georgia results were not available.

• $136 to $145 million in healthcare costs avoided from reducing complications and readmissions compared to baseline for the most recent 12 months reported

• 2,734 complications avoided

• A reduction of 12,092 readmissions (13.4%)

Source: Tennessee Hospital Association

LEARN MORE

Visit www.medicare.gov/hospitalcompare to find out more about how local hospitals compare on the national scale in factors like readmissions and hospital-related complications.

Hospitals are not always the place to get better.

All too often, they are places where patients are harmed — through infections developed there, a fall, or a botched procedure.

And in too many cases, patients end up back at the hospital just weeks after they left.

It’s been a stubborn problem nationwide: For five years, the percentage of hospital readmissions did not budge. Hospital-acquired conditions — which include everything from falls to infections to getting pneumonia from a ventilator — afflicted 14 percent of patients discharged in 2010.

But that seems to be changing.

Over the last three years, readmission numbers among Medicare patients fell from 19 percent to 17.5 percent, an analysis released last week by the U.S. Department of Health and Human Services shows.

And the number of hospital-acquired conditions also dropped by 9 percent over the past three years, from 145 per 1,000 patients in 2010 to 132 in 2012.

The drop translates to 15,000 lives and $4 billion saved just through hospital improvements, the federal agency says. It also means 150,000 fewer patients were readmitted to a hospital, and more than half a million were spared problems like infections or falls.

A group of 63 Tennessee hospitals has also seen a 13 percent reduction in readmissions. While Chattanooga’s three hospitals, Erlanger Health System, Memorial Health System and Parkridge Health Care System are all a part of the group, hospital-specific numbers were not available.

Experts point to several reasons for the improvement. For one, a new system of government-issued penalties has begun to take effect under the Affordable Care Act. Those penalties decrease Medicare payouts by as much as 2.5 percent to hospitals that have too many patients readmitted within 30 days.

“We had been working on many of these quality issues for some time,” said Dr. Woods Blake, chief quality officer for Erlanger Health System. “But anytime CMS says this is going to affect your reimbursements, everyone pays attention.”

Another reason for the decrease, experts believe, is the growing number of public “report cards,” from sources such as the Leapfrog Group or Medicare’s “Hospital Compare” website, which allow the public to scrutinize hospitals’ performance.

And the federal government has been collecting clearer data about readmissions for hospitals to use.

“The data has been a major driving force,” said Dr. Kevin Lewis, chief medical officer of Memorial Health System. “Now that you have routine data that’s publicly reported, you have a better idea of how to benchmark your performance.”

That increased scrutiny on such problems, health experts say, could help make a dent in what they say is some of the biggest waste in health care spending.

GETTING TRACTION

Widespread problems in hospital safety first came on the national radar in 1999, with the publication of a sobering report called “To Err is Human.”

Put out by the U.S. Institute of Medicine, the study showed that as many as 100,000 people died in the U.S. each year from preventable medical errors.

CUTTING READMISSIONS

Patients may be readmitted to the hospital because of something that went wrong during their treatment, but more often it is because they just don’t transition well after being discharged.

They may fail to follow up with a primary care doctor. Or — for convenience or affordability’s sake — forgo taking an important drug.

Others may have failed to absorb their doctor’s bedside instructions because they were medicated or confused.

“Patients are overwhelmed with the hospital experience,” said Donna Bourdon, president of ContinuCare home health services, owned by Erlanger.

Trying to bridge this gap, Chattanooga hospitals have joined a Medicare-sponsored program, the Community Based Care Transitions Program.

“It encourages a patient to be involved,” explained Cheryl Shrum, case manager at Parkridge Medical Center’s emergency department. “And we’ve seen significant reduction in readmissions just in this year.”

The 18-month-old intiative, which works with the Southeast Tennessee Area Agency on Aging, targets Medicare patients with conditions such as heart failure, diabetes, pneumonia and stroke — key diagnoses for which Medicare is trying to reduce readmissions.

Hospital nurses and social workers help patients with a “discharge plan,” and link them with the follow-up program, which includes phone calls and visits to keep patients on track with medications and appointments.

Bourdon cited Erlanger’s participation in a federal drug pricing pricing program, called 340B, as another way to help patients bridge the gap. All discharged patients get their first prescription filled at the hospital pharmacy. If patients can’t afford it, the hospital may help subsidize it or provide it free.

— Kate Harrison

Since then, hospitals have striven to combat chronic problems — like bloodstream infections from venous catheters — with varying degrees of success.

But the new expectations under the ACA have lit a fire under providers and other organizations to become more strategic.

“This is the realization of more than a decade trying to get traction in these areas,” Lewis said.

The growing body of data about hospital-related harm, coupled with the threat of slashed reimbursement rates made for a serious wake-up call, said Lisa Slattery, vice president of quality management for BlueCross BlueShield of Tennessee.

“The light has really been shed on this within the last couple of years,” said Slattery.

Insurers have long decried the problem of readmissions, but more are forming or funding initiatives to help hospitals improve.

For BlueCross, one such partnership has been with the Tennessee Center for Patient Safety.

That group, under the Tennessee Hospital Association, is one of 27 medical associations nationwide that have partnered with the federal government in a program called “Partnership for Patients,” which seeks to reduce hospital-acquired conditions by 40 percent and hospital readmissions by 20 percent by the end of this year.

In Tennessee, 63 hospitals are participating, said Chris Clarke, senior vice president of the Center for Patient Safety.

“More hospitals are seeing that there is an art and a science about how to do best practices,” said Clarke.

In Tennessee, a big victory has been in the area of early elective deliveries — scheduled births that are not medically necessary before 39 weeks gestation. Those are down 77 percent since 2010.

Hospitals in the group are sharing strategies about what works and what doesn’t, said Clarke.

For example, more Tennessee hospitals are switching how catheters are administered. Instead of a system that relies on a certain doctor to determine when a catheter is unnecessary, a new nurse-led protocol simplifies the process. For local hospitals, that means catheter-related urinary tract infections have dropped as much as 20 percent.

Local hospitals say different quality programs have grown in importance over the last two years. Memorial has revamped its “falls committee,” which investigates every patient fall, and has special navigators to help patients with congestive heart failure transition safely through stages of care. Parkridge, too, has special liaisons to work especially with those who have heart failure and other conditions.

Erlanger has hired specialists who work exclusively to bring down the number of pressure ulcers, and has a new computer system to more closely tracks problems like hospital infections.

Patients may not see all of the behind-the-scenes changes going on at hospitals, Blake says. But that’s fine.

“The expectation for safety is something patients should already have,” he said.

Contact staff writer Kate Harrison at kharrison @timesfreepress.com or 423-757-6673.

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