By GREG RUSSELL
Register Staff Writer
A newly formed department at North Texas Medical Center (NTMC) has helped reduce potential Medicare penalties stemming from chronic patient readmission.
But officials said the addition will be equally beneficial to those repeat patients.
NTMC’s new case management department, in operation since April, uses a special team — case managers and a social worker — that provides intermediaries between potential repeat hospital patients and nearby agencies equally suited to help them.
“This is for high-risk patients who are going to possibly readmit due to a lack of funds or a support system, or co-morbidities or disease,” said Tonya Price, NTMC chief nursing officer.
The desired effect is that the insured patient gets suitable help beyond hospital walls and that in the future, the hospital sustains fewer or no Medicare penalties due to repeatedly allowing certain people to be readmitted following initial treatment.
As a result, the patients are redirected to specialists possibly even more appropriate and may get even quicker care.
“We’re talking hospice, nursing homes, home health, family violence, drug treatment,” said department member Amber Ball. “It’s anything they are going to need keep them well when they get home, because different people have different needs.”
The new department uses its members similar to the way another social agency might intervene in the well-being of clients by helping them find jobs or treatment programs. Ball said her own job includes synthesizing a patient’s hospital discharge with what they need outside the hospital to help treat a condition.
“If they’re in the hospital and they have a home health need or a need to have counseling or rehab, I work with our community to set that up,” she said.
Price gave the example of NTMC’s repeat patients who are congestive heart failure victims, and might not require additional hospital visits if their outpatient treatments were more rigorously monitored.
Such a heart patient who has already undergone treatment at NTMC would be best served by private treatment — but in a timely manner, expedited by members of the NTMC case management department.
“When a heart patient is gaining weight, you don’t want to catch them after they’ve already gained five pounds,” she said. “You want to catch them while they’ve gained two pounds and then drain that extra fluid. You want to get a doctor who can prescribe them the right medication.
“You want to keep them in the setting that is appropriate for them,” Price added. “It’s helping them, it’s decreasing Medicare costs and it’s always making us, at the hospital, reach out of our comfort zone. We’ve got to partner with other community entities for this.”
Price said patient readmission at NTMC is far from a new phenomenon, but hasn’t been a situation of penalty until recent years and now the bottom line is threatened. She said NTMC, plus two major hospitals in Denton, were consulted in 2011 by Donna Zimmerman of HealthPartners, a nonprofit healthcare organization.
She was sent by the state in light of high readmission rates among the three facilities.
“When the state invites you, you pretty much listen,” Price said. “We’d been acknowledged as the three entities to decrease readmission for Medicare patients. The numbers were not favorable.”
NTMC hadn’t actually yet been penalized, but the threat loomed. The hospital was was set to sustain a penalty equaling .10 percent of its Medicare dollars if its readmission situation didn’t change. But Price added that since April, readmission among congestive heart failure patients has decreased from 24 percent to 11.4 percent, removing threat of Medicare fund loss.
And none of this, she said, has been anything but helpful for patients.
“Our goal is that it takes the community to take care of a patient,” Price said, adding later that NTMC examines every hospital admission to assess a risk of readmission. “Is the hospital the best place? For some people, it is. But the answer is not always admitting them to the hospital.”
NTMC Chief Executive Officer Randy Bacus cited the development of the case management department as one of several aimed at reducing hospital readmission while helping improve community health.
The programs, he added, are based on goal timelines of three to five years, and this one has already shown notable success.
“Ironically, our success with these goals has resulted in a decline in inpatient admissions which translates into less business for the hospital,” he said. “However, over the next few years, the whole healthcare industry will be moving from a volume-based, fee-for-service payment system to a value-and-performance-based payment system, which should help us make up for some of the lost business if our hospital can outperform the industry averages.”
For more information, call the hospital at (940) 665-1751.