Readmissions and Community-Based Support

One of the biggest challenges, explains Benfield, is to convince patients and care providers why this extra service may be needed in addition to, say, a visiting nurse or home health program.

The answer is that this program specifically targets avoidable readmissions. "We focus on medication reconciliation, getting patients connected with primary care physicians, and identify those red flags that will send them back to the hospital."

The programs use a variety of models. UniNet, an Omaha, Neb.–based, nonprofit physician hospital organization that provides managed care services to area metropolitan hospitals, has expanded its operation to qualify for the program. UniNet is working with the Eastern Nebraska Office on Aging and five hospitals within Alegent Health to help 8,000 discharged patients a year avoid a readmission. The program in June.

Richard A. Hachten II, Alegent president and CEO, says that apart from the readmissions penalty, preventing readmissions under current fee-for-service payment structures means hospitals will lose money. Nonetheless, he says, Alegent decided to participate "to prepare ourselves and learn everything we can to most effectively manage the health of populations as reimbursement models change. Each of these experiences adds to our knowledge base in effectively managing patients' health."

UniNet uses nurses in the hospital to meet with Medicare patients to evaluate which ones are at highest risk. Depending on their needs, either the nurse follows up with the patients at home after discharge, or if the patients have home health needs, they are referred to the Office on Aging.

The important thing, Hachten says, "is that now it's all a coordinated effort to provide a number of resources" in a way neither the patients nor the hospitals had before.

With the Supreme Court's decision in June, and looming readmission penalties (up to 1% of Medicare DRGs for the first year starting with Oct. 1 discharges, up to 2% in 2013, and up to 3% in 2014), some skeptical hospital organizations are now reconsidering their participation in Section 3026, says Bruce Siegel, CEO of the 170-member National Association of Public Hospitals and Health Systems. In particular, leaders of safety-net hospitals, some of whom are more worried about readmissions penalties than others, "see the train is coming. And I think a lot has changed in the last year, with people more willing to think about models like this that they weren't willing to think about a year ago."

Reprint HLR0912-9

This article appears in the September 2012 issue of HealthLeaders magazine.