As hospitals are hit with first penalties, community-based efforts aim to reduce readmissions
Penalties for hospitals with readmission rates that are too high kick in this week. In the Philadelphia area, five have been assessed the maximum penalty, a 1 percent cut to Medicare payments for the year.
One of those is Pennsylvania Hospital. In the very same health system, the Hospital at the University of Pennsylvania is being penalized almost nothing.
Penn Health System chief medical officer Dr. P.J. Brennan said those disparate rates reflect differences in services provided and patient profiles at each hospital.
"We have a systemwide initiative to prevent readmissions, and the initiative has been more successful at some places and less successful at others," Brennan said. "It probably reflects differences in the patient populations and perhaps differences in execution."
Hospital administrators are quick to point out they can't prevent all readmissions, especially for folks who don't have the support at home to stay healthy.
Brennan said the readmission prevention program is about to expand, and others in the region are starting up.
This week, St. Joseph's University health services professor Ilene Warner-Maron is preaching her message at a regional conference on aging hosted by the Philadelphia Corporation for Aging -- that cutting costly readmissions is not solely the hospital's responsibility.
"You can get them out of heart failure, you can control diabetes, but the issue is what happens when they go back home," Warner-Maron said, "when there's no doctor or nurse telling them to eat this or take this medicine."
She held up as a good example of community-based support a new program the PCA offers patients at Einstein and Temple hospitals. In the program, a case worker will visit homes on the second day after a client is discharged to address daily needs.
"To look at, where are your medicines? Do you actually have them in the house?" Warner-Maron said. "How are you going to get food? Do I need to call your family and say look, there's no food in this house, you need to help out?"
Still, even these community-based interventions only work if a patient is willing to welcome a case worker into his or her home.