Reform Update: Post-discharge care plans promote use of primary care

Providing a solid base of primary-care service and coordinating specialty care for high-risk patients has been advocated as a method of lowering overall healthcare costs. Doing so would presumably reduce repeat hospitalization and emergency department visits. A new study posted on the JAMA Internal Medicine website suggests that such an approach does, indeed, work.

Researchers with University of Pennsylvania Perelman School of Medicine found that when low-income uninsured or Medicaid beneficiary patients at two Philadelphia hospitals were assisted by community health workers in developing an individual recovery plan, they were more likely to have a primary-care visit within 14 days of discharge and to report high-quality post-discharge communication.

Recently, research from the CMS Innovation Center received criticism for its lack of scientific rigor, but the University of Pennsylvania study was a randomized trial in which 222 patients received an individualized discharge plan from community health workers between April 10, 2011, and Oct. 30, 2012, and 224 who did not during that period. It also was noted that the patients studied, ages 18 to 64 years old, were from the general patient population while other, similar studies focused on patients with a specific disease so the results were not necessarily applicable to all patients.

While patients in both groups had similar rates for one 30-day admission, patients who worked with community health workers were less likely to have multiple readmissions.

The community health workers were described as “trained lay people” paid $14 an hour, who served as liaisons between patients and the inpatient care team, helped schedule follow-up appointments and, in some instances, accompanied patients on the visit.

In a formal process to develop care plans, the community health workers established a measurable goal, instilled patient confidence in achieving that goal, and developed a step-by-step plan to reach it.

In an accompanying editorial, Dr. Harrison Alter, an emergency medicine physician with the Alameda Health System in Oakland, Calif., noted that this was an example of using low-cost “upstream” interventions to prevent more expensive treatments downstream.

“If CHWs helping patients with these basic demands can prevent a cascade of hospital admissions and can improve patients' health and well-being at the same time, we should all start looking up the river,” Alter wrote.

The CMS will begin to receive data through its Open Payments program—more commonly known as the Physician Payments Sunshine Act—on Feb. 18, the agency announced in a listserv message to industry stakeholders Friday. The program is meant to build public awareness of financial relationships between drug and device manufacturers, group purchasing organization, and certain healthcare providers.

Starting on the 18, the program's first phase will begin when some organizations will start to submit data to the CMS on payments made to healthcare providers, including gifts, consulting fees and research activities.

In May, manufacturers will complete the second phase when they submit additional, detailed payment information. “Once CMS completes the two phases of data submission, healthcare providers and manufacturers will have an opportunity to review and correct inaccuracies,” the agency noted in the message. “CMS will then post the data on our website by Sept. 30.”

Follow Andis Robeznieks on Twitter: @MHARobeznieks