Nancy suffers from congestive heart failure and diabetes, but has generally been able to keep symptoms
at bay. Complications following recent surgery had her back in the hospital, however, less than a month after her original dismissal.
Now, despite the good care she was receiving at the assisted living facility where she had recently moved, worrisome symptoms had re-emerged. Sensing she may need to make arrangements to transport Nancy to the hospital, the director of the facility was about to meet with the head of the facility's nursing staff.
Then she remembered receiving a copy of the discharge folder the hospital had given Nancy following her most recent stay. Something she read there prompted a quick call to the nurse, followed by a three-way conversation with Nancy's provider.
Instead of asking she be readmitted, the physican made a change in Nancy's medication symptoms began to subside with 24 hours. A few days later, Nancy was feeling well enough to join fellow residents on an outing to a favorite local restaurant. Re-admittance to the hospital had been averted.
Scenarios such as Nancy's are becoming increasingly common in the wake of Medicare's focus on readmission as a means to reduce costs. Two-thirds of the nation's hospitals were hit with fines beginning Oct. 1 for the coming year in the second round of Medicare's readmission penalties, according to the Centers for Medicare & Medicaid Services (CMS).
That figure equates to 2,225 of the nation's 5,700 hospitals receiving reduced payments totaling $227 million. Of those, 18 have received the harshest penalty, losing 2 percent of their Medicare reimbursements, while 154 lost 1 percent or more. Almost 300 hospitals received fines of 1 percent or more in the first round.
While most businesses spend time trying to figure out how to attract more customers, the nation's hospitals find themselves in the unique position of trying to avoid more business—at least when it comes to readmittance of their elderly patients.
Like many hospitals, St. Vincent’s Hospital Westchester has looked to its discharge process for a solution. The 133-bed psychiatric facility in Harrison, N.Y., treats patients for mental illness and addiction, discharging approximately 3,000 inpatients per year.
To reduce readmissions, St. Vincent's took a multi-faceted approach to its discharge process. Among other actions, the facility began giving each patient a well-organized transition folder containing all the information the patient would need once they got home. Having all of this information well-organized as part of a discharge kit reduced the anxiety of the patient and family members.
St. Vincent's adapted its discharge folder from Dr. Brian Jack's "Re-engineered Hosptial Discharge (RED) program at Boston University Medical Center.
Each patient receives a discharge folder that organizes all discharge information, including discharge information materials, aftercare appointments, phone numbers of care providers, emergency contacts, a list of prescribed medications and an individualized packet of information on medication and diagnosis.
Results of the first two years following implementation showed readmissions had decreased by one-third. Patient satisfaction, as evidenced from survey results, soared from 12 percent to 65 percent in the first two years alone.
Attention to discharge process may be benefiting hospitals and patients nationwide. While 1,074 hospitals received higher penalties this time around, including 283 not penalized in the first round, there are still 1,371 hospitals that are seeing a lower fine in the coming year. All told, total readmission penalties across the nation have fallen $53 million.
