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Medicare has reduced payments to hospitals in the Fredericksburg area because their readmission rates are higher than average.
Under the new rules, hospitals will be expected to work with other providers in the community, such as nursing homes, home health agencies, pharmacies and physicians.
Nancy Littlefield, chief nursing officer for Spotsylvania Regional, compared the new program to an orchestral performance, where community providers work side by side.
"It's a whole redesign in the model of care," she said.
Readmissions occur for a variety of reasons, from premature discharge to failure on the part of patients to do what it takes to stay healthy.
About 25 percent of readmitted patients come from group-care settings such as nursing homes, said Dr. Amy Adome, vice president for quality and patient safety at Mary Washington Healthcare.
"The bulk are coming back from their own homes," Adome added.
This means that hospitals will have to strengthen their existing discharge programs. Mary Washington, for example, phones patients on the day after discharge and every few days after that.
They ask if patients have filled their prescriptions, taken their medicines, obtained the necessary medical equipment, and followed up with their primary care doctors and specialists.
In addition, the caseworker might ask a heart failure patient if he is weighing himself daily, watching fluid intake and monitoring the use of salt.
"Our job is to make sure that they know how important this is," Littlefield said.
Ryan said Mary Washington also has been trying to identify early in the stay if a patient is at risk for readmission.
This could include patients who live alone, those without transportation, or those with multiple health problems, such as diabetes, hypertension and high cholesterol.
"It's care practiced in a different way," Ryan said.
Jim Hall: 540/374-5433
Beginning Oct. 1, Medicare has reduced payments to hospitals whose 30-day readmission rates are higher than average. The rates are calculated as a rolling three-year average, beginning with the period June 2008 to July 2011.
The reductions apply to inpatient care under Medicare's fee-for-service coverage. The program applies to patients hospitalized for pneumonia, heart attack and heart failure. However, the readmission can be for any reason and doesn't have to be at the same hospital.
The maximum fine is 1 percent this year. It will increase to 2 percent next year and 3 percent the year after.
The penalties are included in the Affordable Care Act, the 2010 health care reform legislation.