Region lands federal contract to reduce hospital readmissions [The Akron Beacon Journal, Ohio]

Nov. 29--Thousands of area seniors can soon get help staying healthy at home after they leave the hospital.

The Greater Akron-Canton Area Agency on Aging and 10 hospitals throughout the region recently landed a federal contract for a pilot project to help prevent hospital readmissions.

Through the program, Medicare patients who are hospitalized for heart failure, heart attack or pneumonia can work with a health coach from the Area Agency on Aging.

The specially trained nurses and social workers will begin assisting patients before they leave the hospital, said Gary Cook, the Area Agency on Aging's chief operating officer. The coaches will continue to provide help through follow-up visits and calls to the patients' homes, whether they live independently or in a nursing home.

The goal is to empower patients "to take care of themselves" by understanding and following discharge instructions, taking their medications properly and going to doctor appointments, Cook said.

"They can very efficiently prevent a lot of these readmissions by simply meeting with the person in their home and providing them with coaching so they can manage their own diagnoses," Cook said. "The basic reason for most avoidable readmissions are patient self-management issues."

The Akron-area partnership is one of seven projects nationwide selected to participate in the federal Community-Based Care Transitions Program. Others include collaborative efforts in Cincinnati, Atlanta, Chicago, Maine, Arizona and Massachusetts.

The program was created through the federal health reform law passed last year as a way to help hospitals develop partnerships that prevent patients from having problems after discharge. A total of $500 million is available over a five-year span.

The federal initiative aims to reduce preventable readmissions among patients covered by Medicare.

The 30-day readmission rate among Ohio hospitals is 19.8 percent, according to the Commonweath Fund, a nonprofit group that promotes medical system improvements. Nationwide, the readmission rate is 17.5 percent.

Estimated savings

Each hospital readmission costs the Medicare program an average of $9,600, the Area Agency on Aging's Cook said. He estimates the pilot program can save Medicare$2.7 million annually by cutting local readmissions in half.

Medicare is the federal health insurance program for millions of people ages 65 and older and some younger disabled Americans.

"Lack of coordinated care between hospitals and caretakers such as nursing homes or home health providers can sometimes result in medical complications and costly, potentially avoidable return trips to the hospital," Dr. Donald M. Berwick, administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), said in a news release. "These programs will be looking at methods to improve collaboration among caregivers to promote better health and better use of health-care dollars."

Hospitals are under increasing pressure to reduce the number of patients who come back within 30 days after discharge. Beginning in October 2012, Medicare can withhold a portion of inpatient Medicare payments to hospitals that have a "higher-than-expected" readmission rate for heart failure, heart attack and pneumonia patients.

"It is confusing when you don't feel well and you're being discharged to keep everything straight," said Marianne Lorini, president and chief executive of the Akron Regional Hospital Association. "I think it's great to have somebody who can help be that support, that connector from hospital to home. I think we're going to get some great results and positive outcomes from this."

Participating hospitals

Participating Akron-area hospitals include Affinity Medical Center in Massillon; Aultman Hospital and Mercy Medical Center in Canton; Akron General Medical Center and Summa Akron City and St. Thomas hospitals in Akron; Summa Barberton Hospital; Summa Western Reserve Hospital in Cuyahoga Falls; Robinson Memorial Hospital in Ravenna, and Summa Wadsworth-Rittman Hospital in Wadsworth.

The project is the latest effort by the Area Agency on Aging to ease the transition from hospital to home for elderly patients. The agency already has been working within area hospitals on initiatives to help patients make a smoother transition. Under the new two-year contract with CMS, the Area Agency on Aging will be paid for each patient who receives care from a transition coach, Cook said. If successful, the contract can be renewed for another three years.

The total contract could end up being a multi-million dollar deal, depending on how many patients are seen. But CMS declined to release the per-patient payment amounts because proposals still are being submitted from other potential participants.

Cook estimates as many as 4,000 patients could receive services through the program annually. About 14 additional people likely will be hired to provide coaching for patients.

Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.

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