A Hospital Prevents Readmissions, but Threatens Revenue

Cheryl Clark, February 10, 2011

An asthma prevention program at Children's Hospital Boston has drastically reduced emergency room visits and hospitalizations. But the program underscores the tension between a hospital's quest for quality and its bottom line.

The Community Asthma Initiative buys $150 vacuum cleaners and dust mite-proof bedding for the homes of its patients. And that speaks to what's right with the healthcare system.

But it also speaks to what's wrong with it.

Now five years into the program, 626 low-income asthmatic children who used to have expensive, frequent episodes of hospital care have been enrolled. In addition to the vacuums and bedding, families receive other non-toxic ways to reduce other pests, such as garbage cans with tight covers or copper gauze to fill in holes, all worth up to $300. They also get help with eliminating household clutter that traps dust. And an exterminator may be called in to deal with rodents.

Families also receive case management home visits, environmental assessments to detect household mold and moisture. In rare cases, city inspectors are nudged to pressure landlords to repair or seal areas with obvious mold or water leaks.

So far, the program is a quality success, reducing emergency room visits by 62%. Hospitalizations are down 82%. According to Children's, the average asthma hospital costs per child in CAI including all hospitalizations and ED visits are about $3,000.

And it costs about $2,600 per child, but avoids $3,900 in hospitalization costs over a two-year period, hospital officials say. Elizabeth Woods, MD, who directs the hospital's initiative, says cost analyses point to a 1.46 return on investment. The hospital has papers in press that illuminate its progress.


Facebook icon
LinkedIn icon
Twitter icon