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From this week's In Other News Growth Rx: Keep patients away By: Mike Colias November 02, 2009 Tom Cornwell is on pace this month to make his 25,000th career house call, a milestone that has cost his employer millions of dollars in forgone revenue by keeping sick patients out of the hospital. "They're paying me to keep business away," says Dr. Cornwell, a geriatrician who has worked for Central DuPage Hospital for 12 years. "But it makes perfect sense to give the sickest patients good care at home so they don't have to go to the hospital unnecessarily." Many local hospitals are arriving at that same conclusion, prodded in part by measures included in sweeping health reform bills grinding through Congress that would penalize hospitals that have a revolving door for chronically sick patients, a big driver of rising medical costs. The hospitals are beefing up home-care services to more closely monitor those patients in hopes of preventing costly readmissions — and a future hit to the bottom line. "Home care has become a strategic opportunity for hospitals because of incentives that are coming to prevent unnecessary admissions and improve long-term outcomes," says Nathan Cohen, a senior analyst at Sg2, a health care consultancy in Skokie. Illinois hospitals have more work to do than most: A study published in the New England Journal of Medicine in April found that 21.7% of Medicare patients discharged from Illinois hospitals in 2004 returned within a month — the nation's fourth-highest rate. Advocate Health Care recently began a program that keeps patients with deep vein thrombosis at home, where nurses administer blood thinners to prevent deadly blood clots from forming. Another initiative started last summer for heart-failure patients sent home from Advocate Lutheran General Hospital monitors them through remote devices that detect red flags like sudden weight gain. Officials expect both efforts to keep some of those patients out of hospital beds. "We are bullish on the patient home as a future setting for delivering increasingly complex clinical care," says Scott Powder, senior vice-president of strategic planning and growth at Advocate, which runs nine hospitals and is the state's largest medical provider. 'EPISODE OF CARE' Today, hospitals generally get paid every time a patient gets admitted — even if that patient's return could have been avoided by, say, a nurse's follow-up visit that discovers he or she had run out of medicine. Health-reform bills now under review in both the House and Senate would create pilot programs to evaluate "bundling" payments for an "episode of care," which sets a flat rate regardless of how many times the patient gets admitted. Other measures would slap penalties on hospitals with high preventable-readmission rates and reward health systems that show they work closely with doctors to manage patients' treatment regimens. Starting in the 1990s, many hospitals either sold off or neglected their home-care units because the federal government squeezed reimbursement rates. But in recent years, as the feds and private insurers have placed a bigger premium on coordinated care, more hospitals are investing in the units, Mr. Cohen says. TREATING AT HOME Public reporting of how hospitals are doing with chronically ill patients is another driving factor. The federal Medicare program last summer posted results for the first time on re-admission rates. The readmission rate for heart failure patients at Alexian Brothers Medical Center in Elk Grove Village was 28% — worse than the 24.5% national average. That prompted hospital officials to take a harder look at what was wrong, says Carlotta Rinke, assistant vice-president of quality and patient safety at the medical center. Hospital officials found that 49% of patients who had been readmitted were sent home without a referral for home-care services, while patients who got formal care in the home accounted only for 21% of readmissions. And for patients monitored remotely with electronic devices, the rate was below 20%. "The goal is to treat as many patients at home as possible to avoid having them come back," Dr. Rinke says. Chicago-based Resurrection Health Care's home-care division now has 19 remote monitors, which cost roughly $3,000 apiece. The heart- and lung-disease patients who use them are 16% less likely to be readmitted to the hospital within a month of leaving, says Myrna Zalesny, a nurse who runs the remote-monitoring program. The payoff for that sort of investment won't be clear until the financial incentives are clearer. Still, the millions of dollars that Central DuPage has spent on Dr. Cornwell's house-calls program will pay off, says Michael Vivoda, an executive vice-president. "At the end of the day, the right thing for patients will eventually get paid for," he says. ©2009 by Crain Communications Inc.
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