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Posted: October 13, 2012 6:50 p.m.

Obamacare pushes fewer readmissions

Hospitals all across the nation are seeking to reduce patient readmissions following the Oct. 1 implementation of an Obamacare regulation that penalizes hospitals for having high readmission rates due to complications within 30 days of being discharged.

The hospital authority board of directors that oversees Newton Medical Center discussed ways to prevent Medicare patients from having to visit the hospital repeatedly for the same illness.

Hospital CEO Jim Weadick said improvements wouldn't be simple, but marketing director Linda Moseley said steps could include communicating better with patients and fellow health care providers like assisted living facilities and rehabilitation centers.

Part of the Affordable Care Act, which was signed into law in 2010, is the Hospital Readmissions Reduction Program, which seeks to incentive hospitals to keep readmissions down by penalizing hospitals by giving them smaller payments for care provided to readmitted patients.

The better hospitals perform in reducing admissions within 30 days, the less they'll be penalized. The penalty will be based on the ratio of actual to expected readmission cases.

In fiscal year 2013, penalties will range from 0.01 percent to a maximum payment reduction of 1 percent. That maximum penalty increases to 2 percent in fiscal year 2014 and would be capped at 3 percent for fiscal year 2015 and beyond.

The penalties are part of a broader push under President Barack Obama's health care law to improve quality while also trying to save taxpayers money.

About two-thirds of the hospitals serving Medicare patients, or some 2,200 facilities, will be hit with penalties averaging around $125,000 per facility this coming year, according to government estimates.

Data to assess the penalties have been collected and crunched, and Medicare has shared the results with individual hospitals. Medicare plans to post details online later in October, and people can look up how their community hospitals performed by using the agency's "Hospital Compare" website.

It adds up to a new way of doing business for hospitals, and, nationally, they have scrambled to prepare for well over a year. They are working on ways to improve communication with rehabilitation centers and doctors who follow patients after they're released, as well as connecting individually with patients.

"Preventing readmissions in the hospital is not just one simple thing. It's a number of different behaviors you have to enter into so as to keep to enter into so as to keep people from retreading to the hospital within 30 days of when they have been discharged," Weadick said.

Moseley, who's also in charge of business development, said the hospital is looking at developing transitional care teams, individual multi-discipline discharge care plans and patient care conferences.

"Newton Medical Center has joined forces with multiple care facilities in the area to help reduce readmissions," Moseley said. "We are partnered with nursing homes, assisted living facilities and rehabilitation facilities to develop better plans for what care is need once a patient leaves the hospital and goes home to their particular facility."
The individual multi-discipline discharge care plan is for patients that have been readmitted and have multiple chronic medical conditions.

"[This] plan addresses the patient's medical needs, but also coordinates one-on-one assistance with daily obstacles that could hinder a patient staying well," she said.

Moseley said under this care plan, the hospital would ask patients specific personal questions such as if they had money for their medication, whether or not they had transportation and if someone lived in the home with the patient.

She said with the patient care conferences, the hospital would gather a team which would consist of physical therapy, social services, nurses, physicians and a dietitian for the patient to ensure that the received the best care.

"These conferences are for patients that have multiple co-morbidities and considered high-risk for a readmission," Moseley said. "The team will meet to discuss the best plan for the patient."

Nationally, industry officials say they have misgivings about being held liable for circumstances beyond their control. They also complain that facilities serving low-income people, including many major teaching hospitals, are much more likely to be fined, raising questions of fairness.

"Readmissions are partially within the control of the hospital and partially within the control of others," said Nancy Foster, vice president for quality and safety at the American Hospital Association.

Consumer advocates say Medicare's nudge to hospitals is long overdue and not nearly stiff enough.

"It's modest, but it's a start," said Dr. John Santa, director of the Consumer Reports Health Ratings Center. "Should we be surprised that industry is objecting? You would expect them to object to anything that changes the status quo."

Excessive rates of readmission are only part of the problem of high costs and uneven quality in the U.S. health care system. While some estimates put readmission rates as high as 20 percent, a congressional agency says the level of preventable readmissions is much lower. About 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for a potentially preventable problem, said the Medicare Payment Advisory Commission, known as MedPAC.

The Associated Press contributed to this story.

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