St. John Providence Hospital in Southfield is focusing on difficult-to-manage heart failure patients and also seeing positive results in a small pilot study using a telemedicine device, said Shukri David, M.D., the hospital's chief of cardiology.
The telemonitoring approach "could save hospitals millions of dollars if it turns out to be beneficial" because the typical admission costs patients or insurers $20,000 to $40,000 per stay, depending on the condition, David said.
While national and state data are just starting to show improvements, most hospitals in Michigan are feeling the pinch by the dual loss of admission revenue and up to 1% Medicare reimbursement reduction penalties this year for patients readmitted with congestive heart failure, heart attack and pneumonia conditions.
Despite reducing readmissions, for example, Beaumont Health System in Royal Oak will lose $2.3 million in Medicare reimbursement this year, Dearborn-based Oakwood Hospital and Medical Center stands to lose $1.2 million and St. John Providence Health System in Warren expects to lose $2.3 million.
Henry Ford Health System projects it will lose $2.2 million for having higher-than-average readmission rates the past three years. Some $1 million of those cuts will come from Henry Ford Hospital in Detroit.
But those losses for the Henry Ford system will increase in 2014 to $4.3 million, including $2 million at Henry Ford Hospital, because the penalties will increase to 2% in 2014 and 3% in 2015.
The readmission penalties are part of a broader push under healthcare reform to improve quality while saving money. Medicare plans to add other conditions to the list in coming years.
Peter Schonfeld, senior vice president for of policy and data services with the Lansing-based Michigan Health and Hospital Association, said hospitals are doing a much better job at identifying areas in which they need to improve to reduce the financial penalties.
"We are seeing incremental improvement on readmission rates, but there is a fair amount of variation on who is hit on the penalty," Schonfeld said.
"It is high on the list of every hospital because it is lost revenue."
Alvin "Skip" Strauchman, executive director of the Michigan unit of IPC-The Hospitalist Company, a North Hollywood, Calif.-based hospitalist company, said hospitals have a long way to go to develop complete systems to reduce readmissions, but they are making progress.
IPC Michigan, which has offices in Troy and Livonia, has contracts with many health systems in Southeast Michigan and more than 30 hospitals and 70 post-acute care facilities in Michigan. Hospitalists are hospital-based physicians, generally internists, who specialize in inpatient care.
Strauchman said challenges to lowering readmissions include patients self-selecting inefficient long-term care facilities, patients going home and not complying with hospital discharge instructions, and hospital discharge departments failing to more involve physicians in choice of home health agencies.
"Hospitals haven't paid enough attention to what services are provided in skilled nursing and rehabilitation facilities," Strauchman said. "If you send a patient to a facility and the attending doctor only sees the patient once a week, that is not enough to catch the early decline.
"If you have a provider in the facility five to seven days a week, they will see that patient, identify early decline and keep the patient out of the hospital."