ENC Features
2:16 pm
Mon February 11, 2013

Medicare and the Affordable Care Act

President Obama signed the Affordable Care Act four years ago. It's still being implemented. Last month a change in the Medicare system is fining hospitals the reimbursement money they get back for their services, if certain patients are readmitted to a hospital within a thirty-day period of their initial admission. Stephen O'Connell has more.

The Medicare Readmissions Reduction program penalizes hospitals for three common causes of admission, Congestive Heart Failure, Pneumonia, and Heart Attacks. Congestive Heart Failure and Pneumonia are the number one and number two reasons for admission and readmission in the country, respectively. Vice President of Financial Services at Wayne Memorial Hospital, Rebbeca Craig.

"Medicare recognized over many years that about 20 percent of all Medicare patients were readmitted to hospitals within thirty days, and so the thought was if 1 in 5 of Medicare admissions is a readmission that the Medicare program could save money and I'm sure their hope is that medicare patients would get better treatment, if medicare could figure out a way to incentivize hospitals to try to minimize the number of patients that were readmitted within thirty days."

Hospitals and state entities in Eastern North Carolina are developing methods to improve the quality of care both in the hospital, and out of the hospital. Education Programs, State collaborations, and Telehealth systems are some of the ways in which hospitals are trying to do that. The North Carolina Hospital Association, whose main mission is to advocate, educate and lobby for hospitals, is helping. Vice President for Public Relations at the Hospital Association, Don Dalton, says that through initiatives such as Community Care of North Carolina doctors are becoming leaders in improving health care practices.

"The Community Care networks are made up of physicians and so that makes them the ideal people to be the lead in a regional context for this type of work."
When a Medicare patient goes into the hospital, Medicare gives the hospital a set payment for that specific diagnosis. Very often hospitals costs for treatment exceed the Medicare reimbursements. Through The Medicare readmissions reduction program, hospitals may be encouraged to not make unnecessary diagnoses.

"One of the things in our field that's been pointed out many, many times in the past twenty years is the variation of care, not only in hospitals but outside of hospitals and that by standardizing care, and learning what best practices are we would not only reduce readmissions but we would also have a tool to use to bring the cost of care down."

Vidant Medical Center in Greenville works in conjunction with E.C.U's School of
Medicine. According to the hospital compare website Vidant has the same readmission rate as the national average. Physician at Vidant Medical Center, and asst. professor of cardiovascular sciences at East Carolina University, Dr. John Cayhill treats chronic diseases like Congestive Heart Failure.

" We're proposing to set up heart management programs through the whole eastern part of the state aided by the vidant network, so we're really putting in place the protocols for heart failure management and facilitating local providers in providing high quality heart failure management locally and where patients live."
Cayhill says the heart management programs will help standardize care.

" When you have an established diagnosis of heart failure the support program is to try to halt the progression of the disease or to try to reverse the progression of the disease with a combination of medication, potentially advanced therapies, and a great deal of education for the patient."

When asked about complications in developing standards of care Dr. Cayhill said access to patients was the biggest hurdle. Most of the programs for hospitals we talked to were centered on the idea of creating communication networks that can reach longer distances, with more cost effective results.

Catherine Barmer is Outreach Services Coordinator at Carteret General Hospital in Morehead City. Carteret General also has the same readmission rates as the national average. To help lower the rates of readmission for their patients Barmer has been using Tele health technology to monitor heart patients on a day to day basis.

"The biggest obstacle is when you have to have that conversation with the patient that is ready to be discharged from the program, because they don't want to give it up, I think there's a sense of security that there's someone there and watching you, and so I think from a patient satisfaction stand point it's also very successful."

Carteret General's outreach program began in April. One of the first customers for the telehealth machine was Peter Flood. Flood had been into the hospital three times within a short period, and at the end of his third visit the staff asked him if he'd want to try a new at-home system. Flood left that day with the monitor and instructions.

" If you answer the question are you having trouble breathing, or do you feel more bloated, or are you having trouble urinating, or anything, are you taking your medicine, or are you out, it's instantaneous almost, within ten or fifteen minutes someone's calling you on the phone, and saying what kind of problem are you having and then advising you to call your doctor immediately."

Over the five months he used the machine Flood learned how to closely monitor his body functions and how to better communicate with his physician.

"I've learned that it is important to take your medications when you're supposed to take them, at the rate, and not skip any medications, which sometimes you have a tendency to do that, as I said the machine will ask did you take all of your medications today, and if not which ones, and if you say no they're going to call and ask why you didn't take it."

Flood was on the program for the past six months. He finished just weeks ago. He says he wishes he could've kept the machine, but understands how it worked and how to behave as if he still has the assurance of the health care team at his fingertips. Catherine Barmer hopes to find more patients like Flood that can learn to act independently with the help of the machine.

Along with the Medicare Readmissions Reduction Program, another Medicare program took effect on October 20th called the Hospital Value Based Purchasing Program. Through a payment system, the program rewards hospitals that score high in two areas of care, improvement of clinical procedures and the patient experience.