A suburban Atlanta pilot program might help light the way in reducing Medicare beneficiaries’ hospital stays, a major contributor to high costs and patient misery across the nation’s health care system.
An article this week in the Journal of the American Medical Association details the success of 14 demonstration programs across the country in reducing hospitalizations in 2009 and 2010 in Medicare, the federal health insurance program for people age 65 and older.
One of the programs was in Atlanta’s eastern suburbs and included Gwinnett Medical Center, Eastside Medical Center, Rockdale Medical Center and Newton Medical Center along with a dozen nursing homes and other groups such as home health organizations that care for area seniors.
The goal was to foster better coordination among those care providers when patients are in transition from one of them to another. Too often Medicare providers operate in silos as they are paid for discrete aspects of care, said Dr. Kimberly Rask, the medical director for quality improvement at the Georgia Medical Care Foundation.
“Nobody’s really got an incentive to follow the patient across all those sites of care, make sure they’re talking to each other,” Rask said.
Rask led the Atlanta-area program and has since expanded it to 12 sites across the state, and the Centers for Medicare and Medicaid Services is funding such programs nationwide.
Taming increasing Medicare costs is one of the primary conundrums in Washington’s long-term budget debate. The money saved by these programs can add up: Rask said preventing 80 hospital admissions in one community saved Medicare about $750,000 in a year. Medicare calculated the overall cost of avoidable readmissions at $17.5 billion in 2010.
This week’s study found about two fewer hospitalizations per 1,000 Medicare beneficiaries per quarter in the pilot programs, compared to surrounding communities. But the study found no change in readmissions as a percentage of all hospital discharges.
The study predates the 2010 Affordable Care Act, but as the law is being implemented it is spurring the spread of such coordinated approaches to patient care. An aspect of the law that went into effect last fall reduces Medicare payments to hospitals that do not meet certain benchmarks for readmissions for heart attacks, heart failure and pneumonia.
Gwinnett Medical Center has sought to reduce readmissions by hiring hospital-based “coaches” who counsel patients on proper care before and after they are discharged and can provide such necessities as meals and rides. Chief Medical Officer Alan Bier said the Care Transitions Program — a regionwide initiative through the Atlanta Regional Commission that started last year — helps the hospital avoid “financial penalties” but “the best reason to be doing this is because it is the right thing to do for our patients.”
Neale Chumbler, the head of the department of health policy and management at the University of Georgia, said readmission penalties could have a disproportionate effect on hospitals in poorer areas, so Medicare must be careful. But overall, Chumbler said the penalty will spur positive developments.
“What you’re seeing is a modification or transformation in trying to equip the patient to take care of themselves more, be more in the home-based environment,” he said. “… This is definitely the movement of health care as it evolves through Obamacare.”
Originally published in the AJC
– Daniel Malloy
Posted January 25, 2013.