While Lawrence Memorial Hospital significantly reduced its pneumonia re-admission rates from 2012 to 2013, the hospital has begun being penalized under a federal program to cut down on re-admissions.
In an effort to reduce spending on health care, the Affordable Care Act, or Obamacare, in October 2012 began decreasing hospitals' Medicare reimbursement rates if Medicare patients were being re-admitted too soon after discharge. Hospitals across the country began implementing programs specifically to lower re-admissions.
LMH Community Care Navigator
JoAnne Bair, CM, RN, BSN
For instance, LMH brought on a community care navigator to help coordinate and follow up on patients' care after they left the hospital.
In the first year of the federal program, which looks at a three-year span of 30-day re-admission rates, LMH was one of the few hospitals in the region not to be penalized. This fiscal year, however, the government is reducing the hospital's Medicare reimbursement by 0.08 percent (out of a maximum 2 percent).
LMH has been focusing much of its efforts on reducing the number of pneumonia patients who are re-admitted. That rate fell from 20.8 percent in 2012 to 6.6 percent last year, LMH trustee Jane Blocher reported to her fellow hospital board members this week.
Here's how LMH did it, according to Blocher: While patients with pneumonia are still in the hospital, they meet with a respiratory therapist who makes sure they know how to take their medication, receive respiratory treatment or therapy and manage their disease. The therapist also arranges for the patient to see a primary care physician in three to five days.
After the patient is discharged, hospital's community care navigator calls within three days to review discharge and care instructions and checks in at least weekly over the next month, in some cases providing disease management coaching.
At LMH, the other two diseases included in the reimbursement penalty program saw an uptick from 2012 to 2013. The rate for congestive heart failure jumped from 17 percent to 25.6 percent, while heart attack re-admissions went from 9.3 percent to 11.9 percent.
Hospital spokeswoman Janice Early noted that the hospital generally sees fewer Medicare patients for those two disorders so any re-admission makes a bigger difference in the numbers. She also said chronic conditions like heart disease are harder for the hospital to have much control over, as they often depend on a patients' lifestyle choices over the course of their lives.
Next fiscal year, which begins Oct. 1, the federal government will also begin penalizing hospitals based on re-admission rates for chronic obstructive pulmonary disease and hip and knee replacements.