Is Mount Sinai Ready To Prevent Readmissions?
Crain’s Health Pulse July 30, 2012
Mount Sinai has spent the past two years preparing for Medicare rules that penalize hospitals with high rates of Medicare readmissions. The rules go into effect Oct. 1. Will the hospital avoid $2.2 million in potential penalties?
"We have a difficult group of patients in East Harlem," said Claudia Colgan, the hospital's vice president for quality initiatives. "Patients who not only have a low level of health literacy, but also some who are actually illiterate."The hospital's Preventable Admissions Care Team identified 1,000 Medicare patients who are high-users of services. The program went into effect prior to the latest Centers for Medicare & Medicaid Services reporting period, when CMS identified Mount Sinai as the only New York hospital having worse-than-average readmissions for heart attack, heart failure and pneumonia patients.
The PACT team began by making an initial bedside visit during a patient's hospitalization to conduct a two-hour interview. "Patients sensed that this time we were doing something different," said Maria Basso-Lipani, a social worker on the team.
After ensuring that each patient was in regular contact with a primary care doctor, the team tried to learn what went on in patients' lives that kept them from following medical orders. One cardiac patient, for example, missed medical appointments because of a broken elevator in her housing project. The Mount Sinai team "bombarded that landlord with phone calls until it was fixed," Ms. Basso-Lipani said.
More than 80% of patients stayed in the program, which has had promising results. In the 60 days before the program's September 2010 start, its patients accounted for 952 hospitalizations. In the six months after the program began, the number of hospitalizations fell to 546. Emergency department visits also dropped to 789 from 1,077 visits during the same period.
Ms. Colgan said PACT could be scaled up. "We've easily got more than 4,000 patients who are in Medicare fee-for-service plans alone," she said.