As a physician, I am pleased that the new health-care-reform law is already encouraging positive changes in health-care delivery. The Orlando Sentinel article "New Efforts Keep Seniors Healthy after Hospital Stay" (Thursday) highlighted a pilot program in Miami that has reduced the number of hospital readmissions for senior citizens from 23.3 percent to 2.7 percent. This is important for many reasons, but especially because seniors are able to remain healthy by receiving expanded support from the medical community.
In an effort to minimize readmission rates, hospitals have developed “care transitions” initiatives which were developed to minimize return trips by seniors to hospitals after they have been discharged. It is not enough to hand our seniors a discharge summary at the end of their stay. They need and deserve better. Many live alone, and just the help of someone else can promote more healing than a plethora of pills. According to an article by Ann Carrns published in Health.usnews.com, “Health Reform Takes Aim at Hospital Readmission Rates”, 20 percent of hospitalized Medicare patients are readmitted within 30 days at a cost of $17 billion dollars a year. According to Carrns, 50 percent of these patients do not see a physician between their hospital stays for follow-up.
I am reminded of my own departed mother, who was hospitalized three months after I began my first year of medical school. My mother was a widow and had no family support. Upon her discharge, she was given a home attendant by the hospital social worker. The home attendant made sure that she took her medications, kept her medical appointments and provided the human contact that she needed.
The use of nurses as "coaches" to assist discharged seniors is medicine practiced at its best. In the article, the senior who returned to the emergency room in heart failure because he was uncertain where to get his medications refilled is a prime example of a regrettable and expensive complication that could have been avoided by implementing a simple solution. Carnn discusses a medical study that says as the number of hospital days decreased, the readmission rate increased by three percent. Cardiac arrests, pneumonia and heart failure are the most common reasons for hospital readmissions of the Medicare population.
Under the Affordable Care Act (ACA), Medicare penalties and a recoup of payments will take effect in October 2012 for hospital readmissions of pneumonia, heart attacks and heart failure. A hospital’s total Medicare payments can be reduced by 1 percent in 2012, 2 percent in 2013 and 3 percent in 2014. Therefore, there are economic incentives to prevent readmissions of senior citizens. Advanced technology and innovation such as telemedicine, frequent nursing and virtual home visits and enhanced interactive patient education plans are just some of the ways hospitals are attempting to improve care for seniors.
We are now entering the age of accountability. Hospitals will soon be penalized fiscally based on their readmission rates. The use of nurse coaches and social workers to assist our most vulnerable senior population will not only save money but also lives as well.