Improving discharge process helps Hunterdon Medical Center reduce readmission rates
This article by Cristina Rojas originally appeared in the Hunterdon County Democrat. To read the full article, click here
Hunterdon Medical Center ranked better than most hospitals in the nation at limiting Medicare patients from having to return within 30 days, thanks in part to its efforts to give patients plenty of information and support to help them after they leave.
New Jersey ranked 50th of 53 states, including the District of Columbia, Puerto Rico and the Virgin Islands, in readmissions in 2011, but Hunterdon County’s rate was below both the state and national average.
In the first half of 2011, its rate was 17.7 percent and in the second half of the year, 16.6 percent, for an average of 17.15 percent compared with the statewide average of 21.18 percent.
“Many re-hospitalizations are avoidable,” said Andrew Miller, medical director of Healthcare Quality Strategies, which released the data. “Nobody can tell you what that real number is in any given place, but a good percentage of them are preventable.”
Miller said hospitals, primary care physicians, home health agencies, visiting nurse organizations, county offices on aging, pharmacies, mental health providers and social services all play a role in helping patients monitor and manage their condition.
“It’s a community-wide issue,” he said of reducing repeat hospitalizations.
Hunterdon Healthcare System put together a committee to look at the issue with an initial focus on congestive heart failure, said Dr. Robert Coates, vice president of medical affairs.
“You have to look at the quality of the discharge process,” he said. “It’s something that we’ve worked on quite a bit.”
The hospital, for example, looks at the medications the patient comes in with and the ones they were on during their stay, takes the best of both and sends patients home with a complete list of medications.
“It’s a very difficult thing,” Coates said. “We don’t think we do it perfectly, but it’s something that we work on a constant basis.”
The hospital created a green, yellow and red color-coding system for congestive heart failure patients that describes a wide range of symptoms and ranks them so patients know when they should call their doctor, he said.
“You need to educate patients so they know what to be on the lookout for,” he said. “You can intervene early enough so they don’t have to come back into the hospital.”
The county’s readmission rate is low, in large part because of the hospital’s primary care network and home health care program, he said.
“A big part is getting patients back to their cardiologist, family doctor or whoever’s going to follow up with them after the hospital in a timely fashion,” he said, adding that that a follow-up appointment should be within three days of being discharged. “The medical center is the hub and we have spokes out to primary care physicians throughout the county and surrounding counties.”
The survey focused on readmission rates for Medicare patients, but Coates said that the hospital doesn’t treat its elderly patients any differently.
Beginning this year, the health care reform act will penalize hospitals that have higher readmission rates than the expected averages for three conditions: heart attacks, heart failure and pneumonia, Miller said.
Under the Affordable Care Act, hospitals with the highest readmission rates will forfeit 1 percent of the amount they bill Medicare, 2 percent the following year, and 3 percent the year after that.
“That has driven a lot of the attention being paid to readmission rates,” Coates said.