Hospital coalition aims to drop patient readmissions
State could penalize local facilities if mandates meant to keep patients from returning aren't met.
Glendale Memorial is one of three local hospitals trying to drive down readmission rates before a state deadline. (Times Community News / September 13, 2012)
Of all the patients readmitted to the three local hospitals — Glendale Adventist, Glendale Memorial and Verdugo Hills — about 35% return within three days, said Terrie Stanley, vice president of strategy and business development for the Partners in Care Foundation.
Even worse, 65% are readmitted within 14 days, she added during a meeting of the Glendale Healthier Community Coalition on Thursday.
Starting Oct. 1, hospitals will need to make sure their readmission rates for patients with pneumonia, congestive heart failure and coronary disease are below a rate established by the Centers for Medicare and Medicaid Services using past information from each site and statistics from hospitals of similar sizes and demographics.
The rate varies by hospital based on the complex formula.
The penalty can mean the loss of up to 1% of a hospital’s annual Medicare base reimbursements.
“That can be significant for some hospitals,” Stanley said.
Already, the first round of penalties has been calculated for fiscal year 2013. Glendale Memorial will lose 1% and Glendale Adventist will lose 0.7%, according to information from the Medicare agency. Verdugo Hills will lose no reimbursements.
The local coalition is seeking a grant for about $2 million annually for up to five years from the Medicare agency to help fund the readmission-reduction effort.
Statewide, the majority of readmitted patients come from skilled nursing facilities, said Chad Vargas, clinical project manager with the Medicare agency and a member of the Glendale coalition.
A pilot project will be launched soon to complete a transfer form that would be assigned to each patient released to a skilled nursing facility, Vargas said, so the patient’s medical history can be easily accessed.
“Skilled nursing facilities said, ‘We don’t get from the hospital the information that we need to take care of that patient,’” Vargas said. “And hospitals said, ‘We’re not getting information from the skilled nursing facility to help facilitate the care when (patients) get to the hospital.’”
When released to their homes, some patients deal with several different sets of issues, Stanley said. Some patients don’t see a doctor within the first seven days after being discharged because they either don’t schedule an appointment or have transportation to get to the doctor’s office.
Other patients don’t take their medications as prescribed.
Stanley said she knew of one patient who was on several medications that were supposed to be taken throughout the day. One of the pills, however, had to be taken with meals, so the patient took all of the medications at lunch.
“When they’re back in their homes or in their family environment, what happens many times…is very different from what our medical community thinks is happening,” Stanley said.
To tackle that problem, local hospitals recently began using health coaches who are trained to make sure patients get more involved in their own medical care when discharged.
After an initial consultation in the hospital, coaches visit patients in their homes to prepare them for their follow-up doctor visits and make sure they’re taking their medications properly.
Vargas said outreach efforts are also spreading to medical associations, making sure physicians are aware of the readmission issue.
He noted that skilled nursing facilities have reported that physicians sometimes send patients to hospitals when there may be other options.
Vargas, who works with hospitals and healthcare agencies throughout the state, said the ongoing work of the local 20-year-old coalition will give Glendale an edge when clamping down on readmissions.
“Glendale is ahead of the curve,” he said.
Follow Mark on Twitter @LAMarkKellam.