Dartmouth-Hitchcock's zero-readmission strategy: Focus on value
The Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire is one of only four hospitals in the state to avoid readmission penalties from the Centers for Medicare and Medicaid Services.
The Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire is one of only four hospitals in the state to avoid readmission penalties from the Centers for Medicare and Medicaid Services. It’s an impressive feat considering a recent CMS report found 2,610 hospitals owe $428 million in penalties for readmissions from acute myocardial infarction, heart failure, pneumonia and other diseases.
“By far the most important factor in reducing readmissions is the safety and wellbeing of our patients. This is paramount and why we’ve been on the path to reducing readmissions for more than a decade,” said DHMC chief financial officer Robin Kilfeather-Mackey, who attributes her hospital’s readmission rate to its sustainable health system practices.
TIP: In order to make the value-based model work, hospitals must aspire to provide the highest quality in care.
Kilfeather-Mackey said moving away from fee-for-service payment models towards value-based payment models helps the hospital emphasize value of care over volume, which reduces readmissions. “In fact our payer mix has shifted from 20 percent to 40 percent value-based over the last three years,” Kilfeather-Mackey said. “This is the third year in a row we’ve had this distinction.”
In order to make the value-based model work, the executive said hospitals must aspire to provide the highest quality in care.
Reducing readmission penalties is key to receiving full federal patient reimbursements under Section 3025 of the Affordable Care Act passed in 2012. Hospitals that risked losing 1 percent of federal payments in 2013 could lose 2 percent in 2014 and 3 percent in 2015 for patients readmitted within 30 days of discharge.
Darlene Saler, administrative director of patient flow at Dartmouth-Hitchcock, said readmission reduction requires focusing on everyone from patients to caregivers. “Doing follow up phone calls at discharge will help, but it needs to be combined with education, support services and provider appointments within seven days of discharge.”
According to Saler, DHMC has one of the lowest readmission rates in the country. “We have a strong care management program that, since 2000, has focused not only on transition care for patients leaving the hospital, but on patients with complex care needs who are followed in our primary care sections and specialty clinics,” she said.
Every dollar spent on post-discharge care transition yields $1.09 according to a 2012 article, “An Effectiveness and Cost-Benefit Analysis of a Hospital-Based Transition Program for Elderly Medicare Recipients,” in the Journal of the American Geriatrics Society. “Post discharge care transition programs have a dual benefit of enhancing elderly adults’ self-management skills and abilities and product cost savings,” it states.
Kilfeather-Mackey said hospital financial leaders need to trust their clinical teams and make sure they have the resources they need to succeed. “Make quality and value a priority at the highest level of the organization and maintain a focus on continual improvement,” she said.
Saler said financial leaders should also help clinical staff identify opportunities for improvement that require increased resources. “They would help us look at the return on investment.”
