America needs to move to a model for chronic care
A cover article in USA Today, “Double failure at USA’s hospitals,” published last week, hit me as a sign that the medical community is at last getting the picture that acute care is not enough. This is not to blame hospitals or medical professionals, however.
America’s payment system for care is heavily weighted toward resolving the next crisis.
We may live through the immediate crisis whether it is an operation, a heart attack or stroke.
It is chronic care, the kind of care that we need for multiple long-term conditions, that is suffering, and a failure of consistent follow-up on care after leaving the hospital can send us back too soon.
The article went on to state that too many people die needlessly at U.S. hospitals, according to a sweeping new Medicare analysis showing wide variation in death rates between the best hospitals and the worst.
The analysis examined death rates for heart attacks, heart failure and pneumonia at more than 4,600 hospitals across the U.S. Poorer and very rural area communities were, not surprisingly, most seriously affected by the inconsistency.
The article reported that “researchers also found that the majority of U.S. hospitals operate the equivalent of revolving doors for their patients. One of every four heart failure patients and slightly less than one in five heart attack and pneumonia patients land back in the hospital within 30 days …”
This was noted as the double failure in the system.
First, that care is not consistent among the hospitals but secondly and, especially to my point, that patients are discharged without the kind of follow-up needed to ensure that they will not end up back in the hospital soon after.
The findings are based on examination of more than 1 million deaths and readmis
sions among Medicare patients from 2005 to 2008.
It might be thought that this boomerang effect of repeated discharges and readmissions is inevitable, except that some hospitals are consistently better at avoiding readmissions.
The Baylor Hospital system in Texas, in particular, is highlighted.
Baylor, at 15.9 percent, has the lowest heart failure readmission rate in the country. The question is how does Baylor do it and what could the rest of the system learn from it, if anything.
A follow-up article in the same issue, “Baylor leads the way to lower readmission rates,” suggests that the answer is attention to detail and follow-up care. A Baylor heart specialist team is noted as having visited every heart failure unit in the hospital and talked with every doctor and nurse. Care for patients is scrutinized “at every step of the way,” from the moment they arrive until the moment they leave …” but it does not end there.
One of the most important elements of Baylor’s program is stated to have been to jettison the notion that patients are “discharged” from the hospital.
Instead, hospital workers have begun to think of discharge day as a transition from the hospital to care in the community. To accomplish this and reduce hospital heart failure readmissions, in some cases doctors visit local nursing homes to make sure that the hospital orders are carried out. If palliative (hospice) care is needed, they want to be sure it is provided.
What all of this means is that there needs to be continuity of care.
An association to which I belong, the Life Care Planning Law Firms Association, refers to this as the “continuum of care.”
It is here, with the chronic care model, where we fall short — and this failure is expensive. What attorney members of the LCPLF Association do is employ Care Coordinators on staff to monitor the progress of patients/clients before and after they leave the hospital and throughout their care whether at a nursing facility, assisted living or at home. Diana Christ is our Care Coordinator.
While it might seem that attention to detail would be more expensive, an official at CMS, the government agency that administers Medicare, is reported as stating that the repeated readmissions of heart failure, heart attack and pneumonia patients account for 46 percent of hospital admissions and cost Medicare about $17 billion a year. Prevention as part of ongoing health care reform may not only be more advantageous to clients but also less expensive.
About the Author Janet Colliton
Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.