Submitted by achenault on Wed, 10/22/2014 – 12:41pm
By: Cathy Levine, Executive Director, UHCAN Ohio.
Ten years ago, my mother was readmitted to a suburban New York hospital after shoulder surgery, for a urinary tract infection caused by the catheter used during surgery – considered a preventable infection (they then made her very sick from a test she probably didn’t need). That was my introduction to hospital readmissions for Medicare patients.
A recent Columbus Dispatch article reported that Central Ohio hospitals are paying higher penalties to Medicare, because their readmission rates are not improving at the rate Medicare wants. What’s going on and what do consumers need to know?
Nationally, almost 20% of Medicare patients who are hospitalized are readmitted to the hospital within thirty days for reasons connected to the original admission. Hospital readmissions cost Medicare $17 billion per year – spending that’s largely preventable with better care. But hospital readmissions brought increased revenues to hospitals and taking steps to prevent readmissions cost hospitals money. So, hospitals had financial incentives to maintain the status quo of – until now.
Readmissions happen for several reasons besides hospital-caused complications. A big culprit is inadequate transition planning – for instance, sending a frail older adult home without making sure home care is provided to support recovery. To prevent readmissions, hospitals have to look out for patients after they leave the hospital – either by providing follow-up care or coordinating that care with community-based providers or nursing homes.
To reduce readmissions rates among older adults, Ohio’s Area Agencies on Aging in several regions have established transitions programs using a national model with demonstrated effectiveness.
Another tool for reducing readmissions is the model of enhanced primary care – the so-called “Patient Centered Medical Home,” which is a medical practice that coordinates patient care across settings. PCMH patients who are discharged home from the hospital should expect their doctor’s office to coordinate the patient’s home care.
Medicare’s system of penalties based on unacceptable readmission rates is spurring improvements in patient care and saving money. Why not do the same for Medicaid and privately insured patients? Community Catalyst created model legislation that adjusts payments based on rates of readmissions and other preventable harm. Versions of this legislation is in effect in several states to improve patient safety while saving money.
UHCAN Ohio and Ohio Consumers for Health Coverage have recommended to the Kasich administration that they adopt a similar reimbursement system to reduce readmissions. They received legislative authority to implement it in Medicaid. How much longer must consumers wait?
Submitted by clevine on Thu, 07/28/2011 – 1:58pm
Have you ever had the same medical test repeated twice or more because your different doctors didn’t share the test results? Have you left a doctor’s office confused about what was said or what you were supposed to do? Did you ever feel like you didn’t have all the information you needed to make a decision about surgery or other treatment? Join the club.
Older Adults and Others with Multiple Chronic Conditions Get Uneven Care That Costs Too Much
The problems described above are particularly frequent for older adults and other people with chronic health conditions. In fact, fragmented, uncoordinated care and poor communications among doctors and between doctors and patients contributes to our nation’s high health care costs and uneven outcomes.
Likewise, many emergency department visits and hospitalizations for people with chronic illnesses could be avoided if the patient had better coordination and communication – what is often called, “Patient-centered care.” The Campaign for Better Care has developed “Eight Keys to Better Care,” to state clearly what older adults want from their care.
Patient-Centered Care is the Solution – But Will the Patient be At the Center?
Providers and payers are struggling to develop new models of care that do a more effective job at keeping people with chronic health conditions healthy and out of the hospital. Doing so will improve patient and population health, as well as dramatically lowering health care costs. But can providers and payers (insurers and employers) design more patient-centered care without input from patients?
If you’ve ever heard a doctor complain about patients who don’t follow their instructions or don’t show up for appointments, you’ll know that doctors don’t always know what it’s like to be at the other end of the stethoscope – or what’s getting in the way of patient “compliance.” We need to make sure that older adults and family caregivers, as well as patient advocates, have real input into the design of “patient-centered” primary care models.
New Models of Care Are Being Created Across Ohio – Will Patients and Families Have a Voice?
Efforts to develop patient-centered primary care for patients with chronic conditions are going on in Cincinnati (Aligning Forces for Quality, a project of the Cincinnati Health Improvement Collaborative of Greater Cincinnati), Cleveland (Better Health Greater Cleveland) and Columbus (Access HealthColumbus Primary Care Collaborative), as well as in Ohio’s Medicaid program (the Health Homes Initiative). At the same time, hospitals across the state are engaged in patient safety initiatives, spurred by the HHS “Partnership for Patients.”
The Ohio Campaign for Better Care wants all of these patient-centered primary care and patient safety initiatives to have a strong, effective voice of patients and family caregivers involved in designing and giving input into the model. We’re calling for Patient/Family Advisory Councils (or “PFACs”).
Sign Up to Join the Ohio Campaign for Better Care and get involved with bringing PFACs to Ohio!.
Submitted by clevine on Fri, 06/17/2011 – 3:12pm
The proposed Fiscal Year 2012-2013 budget (in Conference Committee for final touches as of this writing) includes funding and authorization for Ohio to take up the “Health Home” option for Medicaid beneficiaries in the Affordable Care Act. This provision supports the goal of the Governor’s Office of Health Transformation (OHT) to provide better care coordination for people with multiple chronic conditions, including severe mental illness. Better care coordination and disease management will lead to better patient health — and cost savings.
According to OHT, only 4% of Medicaid enrollees account for HALF of Medicaid spending in Ohio. Among those 4% – or “Hot Spotters” – are people with multiple chronic conditions (including severe mental illness) who cycle in and out of high cost institutional settings – emergency rooms and inpatient hospitals – because they lack care coordination and help with disease management (read Atul Gawande’s “Hotspotters” article in the January 17, 2011 New Yorker). Director of Health Ted Wymyslo has already convened a Health Homes Task Force to start planning Ohio’s exciting initiative.
But wait, there’s more. For two years, Ohio will receive a 90:10 match for state investment in Medicaid Health Homes (the feds pay 90%). That’s right: the federal government will turn $4.7 million (Ohio’s proposed investment) into $47 million.
The new matching funds must be spent on essential services for people with serious chronic health conditions that our current, fee for service system, doesn’t pay for. These services include: Comprehensive care management; Care coordination and health promotion; Comprehensive transitional care from inpatient to outpatient settings; Individual and family support; referral to community and social support services, if relevant; the use of health information technology to link services, as feasible and appropriate.
Take one of those: “comprehensive transitional care from inpatient to outpatient settings.” Too many Ohioans, especially older adults and others with chronic health problems, are discharged from the hospital and suffer a preventable readmission because of poor transitional care. Even worse, older adults and people with disabilities too often transition into nursing homes (sometimes with a one-way ticket) simply because they lack transitional care planning to get them back home. That’s a tragedy for people and a rip-off of taxpayers.
So why, then, isn’t Ohio putting more than $4.7 million into the budget for Health Homes? Everyone working on Health Homes in Ohio knows we could certainly create more Health Homes with more money. The answer from lawmakers: “There isn’t more money.”
My answer to lawmakers: Then find more revenue (please, don’t take it from other essential services). If you don’t know where to find revenue, ask the folks at Center for Community Solutions and Policy Matters Ohio. They can point out tax “expenditures” – aka loopholes or tax breaks – for special interests in Ohio law that we can no longer afford. Or the huge income tax cut to the wealthiest Ohioans, who have not shared in the Recession pain that’s leaving too many Ohioans hungry and homeless.
Simple message: Ohio’s budget needs to invest more than $4.7 million in Health Homes.
