Decline in Hospital Readmission Rate and ER Hospital Admissions
In a difficult healthcare environment, where the national average for patients being readmitted to the hospital is excessive, General Medicine, PC, The Post-Hospitalist Company, has worked with the State of Illinois’ Integrated Care Plan to reduce its hospital readmission rate for post-acute Medicaid patients by 18 percent in the first year. In addition, the plan saw a 15 percent decrease in the rate of ER visits resulting in a hospital admission, and a 39 percent decrease in the percentage of high-frequency emergency department users, according to an independent evaluation from the University of Illinois at Chicago.
How did they do it? By using effective systems and care protocols, and by providing appropriate, on-site, more frequent oversight of their patients.
“We are very fortunate to work with excellent managed care partners and case managers who collaborate to improve quality while reducing costs,” says Thomas Prose, MD, MPH, MBA, president and senior medical director of The Post-Hospitalist Company.
The Post-Hospitalist Company sees the new medical specialty of post-hospitalists growing. As hospitalists specializing in the post-acute care environment, The Post-Hospitalist Company physicians and nurse practitioners provide regular, ongoing medical care to patients in long-term acute care hospitals, sub-acute units, nursing homes and skilled nursing facilities, and assisted living/congregate living facilities. It’s a relatively new area of specialty, although The Post-Hospitalist Company has been doing it for 20 years.
“Patients in these environments need quite a bit of care. They often have chronic or complex medical issues that require ongoing care and monitoring. Often they are as sick as patients who are hospitalized, but unfortunately, the post-acute settings do not have the same clinical resources as hospitals,” says Dr. Prose. “There’s a high rate of medication error and staff turnover. So, we provide an increased clinical presence within this challenging environment. We monitor and manage patients, better coordinate their care, and recognize and treat small problems before they turn into big issues that require hospitalization.”
Traditionally, a patient’s primary care physician might be called only when the patient has a serious problem or a condition is worsening. In the typical response, patients are sent to the closest emergency department. For the post-acute patient, this often creates gaps in care. These patients may have conditions such as pulmonary disease or congestive heart failure that produce minor symptoms. Infrequent physician visits can miss these subtle changes, resulting in hospitalizations that are preventable. In fact, six medical conditions are responsible for nearly 80% of the potentially avoidable hospitalizations:
- Congestive Heart Failure
- Urinary Tract Infections
- Chronic Obstructive Pulmonary Disease
“Historically, nursing home or skilled nursing facility patients would have access to a doctor by phone, or a doctor would make rounds once or twice a month. That’s not enough to appropriately manage the needs of these patients,” says Dr. Prose. “Patients don’t go into congestive heart failure in five minutes. There is a gradual decline in condition. We become the patient’s attending physician, and we monitor patients frequently, catch those subtle cues and intervene before their condition deteriorates. We monitor the embers, to prevent forest fires.”
In 2012, Medicare began fining hospitals with high rates of avoidable readmissions, in an effort to trim $8 billion in Medicare costs over six years. Medicare’s national average 30-day hospital readmission rate in 2012 was 18.4 percent. For the past 10 years, The Post-Hospitalist Company has averaged 11.3 percent for its patients, which represents a 40% reduction from the national average.
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