One of the top priorities of the Green Mountain Care Board is to reduce the number of times patients have to return to the hospital for a serious illnesses.
According to a new federal study, roughly 20% of Medicare patients being treated for heart attacks, heart disease or pneumonia are readmitted to the hospital within a month of being discharged.
In an effort to lower this rate, Medicare is penalizing hospitals that have higher rates. Across the country, roughly 2000 hospitals will receive reduced Medicare funding based on their rates.
Two Vermont hospitals will be assessed with small penalties. Fletcher Allen in Burlington and Southwestern Vermont Medical Center in Bennington.
Anya Rader Wallack is the chair of the Green Mountain Care Board – a group that oversees virtually all aspects of health care in Vermont. This issue is one her top priorities.
"It’s one of the most important areas we’re looking at not just because of the costs we know there’s a tremendous amount of excess costs associated with hospitalizations that could be avoided if people had either good primary care or management of chronic conditions but it’s also an issue of quality of care and quality of life," she said.
And Rader Wallack thinks it’s appropriate for Medicare to focus on this issue.
"I think putting a spotlight on it is great. In doing that and actually denying payment you’ve got to be careful that you’re only doing that with unequivocal, avoidable admissions."
Dr. Trey Dobson is the chief medical officer at Southwestern Vermont Medical Center. His hospital is not losing a lot of money – about one tenth of a percent of its Medicare funding. He agrees that this is an issue that needs to be addressed.
"When the patient gets readmitted to the hospital the costs are much higher than they would be if the patient remained in the community connected with their physician, medical home or community care home," said Dobson.
The Medicare study covers the period from June 2008 to June 2011. Dobson says his hospital has implemented programs in the last year that have brought their rate below the federal penalty level.
"Everything from having strong case management, trying to coordinate the care with the patient at the discharge to coordinating with the physicians offices in the community so the patient can get seen soon after discharge," said Dobson. "Rather than having to wait a month before they can see their doctor. Starting in 2011 our numbers go down lower than the national average and well within Vermont’s average."
Because Fletcher Allen’s readmission rate is just above the federal targets, it’s penalty is considerably smaller than the one being imposed on SVMC.