Can Penalties Help Keep Patients Healthy?

Dec 20, 2012

Nearly 1 in 5 Medicare patients ends up back in a hospital bed less than 30 days after being discharged.
Credit Studio Tempura / Flick/Creative Commons

If you’ve just gotten released from Concord hospital, Carriane Wood may be giving you a call.

“Do you have any questions or anything?” she asks a patient.

“It’s at 9:30 on Thursday.”

Wood is a medical assistant, and she’s working her way through a list of recently discharged patients, calling each one to confirm follow-up appointments, and making sure they understand any new prescriptions.

These phone calls are part of a larger movement at hospitals throughout the state and country to reduce hospital readmissions.

Nationally, one out of every five Medicare patients winds up back in the hospital within 30 days of discharge. This costs the government big money: $17 billion each year.

But Dr. Harlan Krumholz, a researcher with the Yale School of Medicine, says it may not take big resources to move the needle.

“A lot of places require additional money to serve people better,” he says.

“But this might be a place where we can help people do better and save money. That’s why it has gotten special attention. It is that potential sweet spot.”

Special attention in the form of financial penalties. If a hospitals’ readmission rate is too high, Medicare now withholds a portion of funding.

This year, Wentworth-Douglas Hospital in Dover and Parkland Medical Center in Derry were hit with the two highest penalties in the state.

Concord Hospital was hit for a modest $25,000. Its chief medical officer, David Green, says it isn’t just money at stake here.

“No matter what your perspective is, whether it’s the patient or the health care institution, you don’t want people in the hospital that don’t need to be there. You want to do the right thing by people.”

So along with follow-up phone calls, Dr. Green says the Hospital is making sure patients are scheduled for appointments before they walk out the door; that patients understand new medications; and that caregivers know when and how to administer any treatment.

These may sound like simple steps, but experts think they can make a huge impact in helping people stay out of a hospital bed.

But with limited resources, Sharon Silow-Carroll says hospitals will need to focus their efforts. She’s a consultant with Health Management Associates.

“The best strategy for hospitals is really to identify and target those patients that are most vulnerable, the highest risk,” says Silow-Carroll.

That includes patients who are uninsured, over 80 years old, or don’t have family supports at home.

And getting attention at home is vital, because we, as patients, are quick to get shown the hospital door.

“Before, you were allowed to stay in the hospital and heal until you were ready to walk out of there and cook your own meal,” says Anne Diefendorf, VP of Patient Safety and Quality at the Foundation for Healthy Communities.

“That has changed so much.”

She says every hospital in the state is focused on this issue right now, trying different strategies and communicating with each other what’s working, and what doesn’t.

That’s good news for patients, but also good for hospital bottom lines. Especially since Medicare readmission penalties are slated to rise next year.