Hospitals committed to lowering patient readmission
Medicare announced in August that the Center for Medicare & Medical Services (CMS) could penalize hospitals in the nation for patient readmissions within 30 days of discharge.
At that point, Dr. Miller was already leading a program to address the problem.
"Medicare readmission rates ought to be in the single digits if we, as a team, do the right things," Dr. Miller said. "That's an aggressive goal and won't be achieved right away.
"But our readmission numbers have dropped by approximately 25 percent in the last year and a half," he said. "The percentages were in the teens."
Medicare has targeted readmission of patients with heart failure, heart attacks and pneumonia.
New Milford and Danbury hospitals were already targeting those three diseases, as well as stroke patients and COPD patients, Dr. Miller said.
"Medicare is always challenging us to do a better job," Dr. Miller said. "The challenge is that factors that can control readmission are not always within our control."
Some 30 to 40 percent of patients will not follow up on appointments with physicians for aftercare treatment, noted Dr. Damanjeet Chaubey, medical director of hospital services at Danbury Hospital.
The average patient admitted to the hospitals is age 75, on 10 medications and suffering from five diseases, making them more susceptible to disease reoccurrence or other illnesses, Dr. Chaubey said.
Socio-economic factors enter in, she said. Does the patient need food stamps? Can the patient afford the medication or the doctor visit?
To reduce readmissions of patients, the hospitals have initiated a procedure including identifying high-risk patients on admission and educating patients about their diseases and aftercare before discharge.
Partnerships with nursing homes and primary care physicians have been established to assure the "oversight" of patients health -- a step designed to keep patients healthy and reduce the need for hospital admission, Dr. Miller explained.
"Whether a patient is going home or into a nursing home, a nurse practitioner will see that patient while he is in the hospital and then follow up on seeing him after discharge," said Mary Kincart, director of medical affairs/quality at New Milford Hospital.
"We have been very successful in reducing readmissions because of this," Mrs. Kincart said. "Occurrence like low-grade infections can be caught by the nurse practitioner who makes an appointment for the patient with their doctor, assuring the need for readmission won't occur."
Forfeitures in Medicare funding will begin in October for New Milford and Danbury hospitals, as it will for more than 2,200 hospitals nationwide.
Penalties are based on readmissions between July 2008 and June 2011.
New Milford will lose .02 percent of its base Medicare reimbursement while Danbury loses .32 percent, according to data compiled by CMS and Kaiser Health.
Dr. Miller said the combined penalty for both hospitals should be "in the hundreds of thousands of dollars range."