Agency to run program to keep Medicare hospital readmissions low

Agency to run program to keep Medicare hospital readmissions low

DANVILLE — Hospital readmissions cost Medicare a lot of money, but a new program to be steered by a Danville agency could keep a lot more Medicare patients from returning to the hospital after they've been discharged.

CRIS Healthy-Aging Center, a comprehensive senior service agency based in Danville, has been chosen to run one of Medicare's new Community-based Care Transition programs, and will be rolling it out this spring in cooperation with Provena United Samaritans Medical Center, Provena Covenant Medical Center and Carle Foundation Hospital.

These programs, created under the Affordable Care Act, are intended to improve transitions for Medicare patients as they move from the hospital to other health care settings, to avoid complications that might require a repeat hospitalization.

The Centers for Medicare and Medicaid Services announced 35 of these new program sites this week, bumping up the total programs in all states to 82.

Medicare already began fining hospitals this past October for excess readmissions. Medicare based fines on each hospital's readmissions for heart attack, congestive heart failure and pneumonia patients.

The fines are intended to force hospitals to work harder to keep patients well after they they've been discharged. Not all readmissions are preventable, but nearly one out of five Medicare patients is readmitted to the hospital within 30 days of leaving, adding $26 billion in added costs a year, according to Medicare.

CRIS Healthy-Aging Center CEO Amy Marchant said her agency will be hiring seven people to handle the new Medicare program and it will focus, initially, on Medicare patients in Champaign and Vermilion counties.

CRIS plans to place one staff person at each of the three hospitals and four people to work out in the field to conduct home care visits with Medicare patients after they leave the hospitals.

The program will be voluntary for patients, she said.

"If they say yes, they have the luxury of continued case coordination at no cost to them," she said.

Because the two Provena hospitals and Carle also serve patients from other East Central Illinois counties, Marchant said, the program will attempt to serve some of those patients as staff time permits.

"We'll likely start with Champaign and Vermilion and get an idea what the case load will be like," she added.

How could this kind of follow-up help prevent a hospital readmission?

When Medicare patients go home from the hospital, sometimes their care-givers during their recovery time are family members with the best of intentions, Marchant said. And sometimes those family members underestimate how much of a time commitment it's going to be, along with their jobs and other family obligations, she said. Then responsibility for the patient's care can begin to break down.

Two of the major ways care breaks down is managing their medications and getting to their follow-up trips to the doctor, said Barb Dalenberg, director of care management at Carle Foundation Hospital.

"This is really intended to help patients get connected with services outside the hospitals so they don't get sicker," she said.

Marchant said she hopes to get the program started in March or April.

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