Krissa Kaisner, a registered nurse in the orthopedics-surgical unit of Advocate BroMenn Medical Center, went over discharge instructions with Karen Wehrmann, 69, of Bloomington before she was released from BroMenn on Nov. 2.
Wehrmann had a total right knee replacement on Oct. 30. Kaisner talked with Wehrmann about when she would follow up with her surgeon, care of her incision site, when the staples would be removed, when the home health nurse would visit, upcoming blood draws, medication management, potential drug interactions and when she should notify her doctor and the hospital if there are complications.
“I think they are very helpful,” Wehrmann said. “They’re not in a hurry to get you out.”
Increased attention to discharge planning (also called discharge education) has become the norm in hospitals. Beginning in October, Medicare began tracking hospital readmission rates for Medicare patients with certain conditions (heart attack, heart failure and pneumonia) and will be penalizing hospitals that readmit more patients than expected within 30 days of discharge.
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To reduce readmission rates, hospitals have been enhancing the discharge planning process.
The change is part of a broad push under President Obama’s Affordable Care Act to improve quality of care while saving taxpayers money.
“This is just one piece of a very big, complex puzzle as we become more accountable for our population,” said Dr. Stephen Hippler, OSF Medical Group vice president for quality and clinical programs.
For the first year, hospitals will be penalized up to 1 percent of their Medicare payments if too many patients are readmitted within 30 days after being treated for heart attack, heart failure and pneumonia. Those conditions represent a large percentage of Medicare patient hospitalizations.
Over several years, penalties gradually increase to 3 percent of Medicare payments. Medicare next is considering holding hospitals accountable for readmissions after joint replacement, stenting, heart bypass and stroke treatment.
Proponents of the change argue readmissions may be life-threatening for patients and add to health care costs. The Medicare Payment Advisory Commission estimated that 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for a potentially preventable problem.
Representatives of several Central Illinois hospitals said they didn’t have Medicare readmission rates because they haven’t had to separate out Medicare beneficiaries’ readmissions in their reports.
But some did have overall readmission rates. For example, 7 percent of inpatients at OSF St. Joseph Medical Center, Bloomington, were readmitted within 30 days of discharge in 2011, which is comparable to Bloomington-Normal, OSF systemwide and state averages, said Dr. Paul Pedersen, St. Joseph vice president and chief medical officer.
All nine Pantagraph-area hospitals’ readmission rates within 30 days of discharge for heart attack, heart failure and pneumonia either were no different from the national rates or, in the case of some small hospitals, the number of cases was too small to use in comparative data, according to www.hospitalcompare.hhs.gov.
National readmission rates were 19.7 percent for patients initially treated for heart attack, 24.7 percent for heart failure and 18.5 percent for pneumonia.
While tying patient outcomes to payments makes sense in principle, factors outside a hospital’s control may reduce patient outcomes, including lack of community and family resources and lack of patient adherence to the prescribed treatment, said Ann Frederick, Advocate BroMenn director of quality and resource management.
In addition, patients may be readmitted for conditions not related to their initial hospitalization.
But, Frederick said, “These types of changes in payment will likely encourage hospitals and health systems to evaluate the entire spectrum of care that they provide and to partner with others providing care for patients after hospital discharge in new and different ways.”