Hospital readmissions are costly not only to Medicare but to the elders and families involved. 

Medicare is trying to recoup some of the approximately $17 billion per year in costs associated with readmissions.  Congress gave the Centers for Medicare and Medicaid Services the power under the Patient Protection and Affordable Care Act to cut hospitals’ pay by up to 1% if they exceed a certain 30-day readmission rate for patients with heart failure, heart attack or pneumonia, starting Oct. 1, 2012. 

The health reform law also set aside $500 million for a readmissions-reduction Medicare pilot program starting this year.  The program that has been created with this funding covers over 47 communities serving high risk beneficiaries across 21 states. It is part of a larger initiative by the Obama Administration called Partnership for Patients, developed to help improve the quality, safety, and affordability of health care.  The Partnership for Patients’ expected goals by 2013 include: • 40% reduction in hospital acquired conditions • 20% reduction in 30-day hospital readmissions • Up to $35 billion in cost savings in 3 years.

There is a lot of disagreement about just how many readmissions can be prevented, but there is agreement that things can be done to improve the system and reduce certain avoidable problems. According to Stephen Jencks, MD, MPH and lead author of a 2009 New England Journal of Medicine study on this issue, about 40% — nearly 1 million rehospitalizations annually — are avoidable.  In a June 2007 report, the Medicare Payment Advisory Commission said three-quarters of readmissions are “potentially preventable.”

Clearly, readmissions are costly to Medicare and carry a great personal cost to the elders and families directly involved.  While certain readmissions will be unavoidable, most experts agree that two simple areas make all the difference in reducing complications and related eldercare costs:

1. Instructions/communications to ensure understanding of post-discharge care
2. Follow-up care after the hospital stay to keep conditions under control (and coordination/set-up of this care)

We invite you to download a copy of our discharge planning checklist (and share!) as a means to help you and your family with ensuring you have all the instructions and information you need, and have asked necessary questions to ensure appropriate follow up care.

When an elder’s transition is not well-managed, problems often arise which may lead to more long-term needs and difficulty recuperating.  Difficulties during this time may lead to an overall decline in activities of daily living and nursing home placement, particularly for elders with multiple conditions or cognitive problems/memory loss.  Clearly, this can be a devastating turn of events for the elder and family, in addition to creating greater care needs and costs.

Hospitalization and discharge are critical times.  If you have a loved one who goes to the hospital, give us a call.  We know you will find it worthwhile to talk with Sue Talbott, our Senior Care Consultant, to get advice and options.  Here are a few of the questions we often get about how and why a geriatric care manager can help:

How does a geriatric care manager help with this process?  Why do I need to bring in an outside party to help?

Though you may have great medical providers and assistance from case managers at the hospital, an outside resource can help you and your medical team effectively navigate the transition.  First of all, this is a stressful time in which your time to make decisions may be very limited.  A care manager can save you a lot of time, stress and money immediately and in the long-term.  Care managers know the variety of resources in the community and can make specific recommendations.  Because care managers work in the community, with clients in all types of situations, we anticipate concerns to help you avoid them.

What about costs?

This is our area of expertise–so we have great efficiency in managing the process for you and working within your parameters. Most importantly, the planning involved helps you potentially avoid costly mistakes.  Care managers do not receive referral fees, so we are not being paid to recommend a certain facility or provider.  Our independent recommendations are tailored to what we think will work best for you, and our experience with providers’ quality of care.  We’re glad to talk with you about how we can help in your situation and budget guidelines.

Need help NOW?  Call us any time at 727-447-5845.