FAIRMONT - News that Mayo Clinic Health System in Fairmont will again be penalized for its readmission rates of Medicare hospital patients didn't come as a great surprise to leadership at the facility. Half the medical centers in the state will lose a small percentage of their Medicare reimbursements.
The Hospital Readmissions Reduction Program, under the federal Affordable Care Act, looks at the rate of readmission for Medicare patients with heart failure, heart attacks and pneumonia within 30 days of their discharge.
The program was implemented last year, when hospital records from July 2008 through June 2011 were examined, revealing the Fairmont hospital had the highest rates in the state for readmission of Medicare patients. This year's recently released report looks at July 2011 through June 2012. Again, Fairmont ranks highest in the state, which will cost the Mayo site 1.15 percent of its Medicare reimbursement starting in October. The impact last year was 0.81 percent of its payments for Medicare discharges.
What the data doesn't show is what's happened at the facility after the first report was released in July 2012.
"We're not seeing results of the measures we've taken," said Dr. Marie Morris, family physician and Fairmont's chief medical officer.
The facility's internal records show readmissions for patients hospitalized for heart attacks is down 8.5 percent; 4 percent for heart failure; and 1.1 percent for pneumonia.
"We took a lot of measures last July and August to address the readmission rate," said administrator Bob Bartingale.
Among those measures is an enterprise-wide Teach Back program, which helps patients and families know what to do when they leave the hospital. The program calls for health care providers to convey information to their patients about their condition, and then to have the patients re-state three important things about their condition.
The idea, explained Morris, is to "check that I've been able to make you understand your condition. ... It's a better model to educate, much better than, 'Do you have any questions?' Because we know the answer to that is 'No.'"
The facility also has started giving its hospital patients a questionaire regarding their diagnosis, which often brings up questions patients might not have thought of on their own, such as what complications they should watch for.
"Care in the hospital is just one piece. Another is transition to your next place of care, to ensure you're successful once you get home," Morris said.
Nurses are also assisting with lowering readmission rates by calling patients with chronic conditions 72 hours after they are dismissed from the hospital. Among their concerns is making sure that prescriptions are filled and that patients understand how and when to take their medication.
Online patient services also has been helpful for those who have taken advantage of it, by giving patients with Internet access the ability to review their diagnosis, prescriptions, test results and more, as well as ask their physician any questions they might have.
Other changes that have taken place since July 2012 include the introduction of the hospitalist model at Fairmont hospital and recruitment of several physicians.
"I don't think we could be more excited with where we are in Fairmont, with stabilization of our providers," Bartingale said. "... I know we're going to see some incredible results because of that."
But going forward, the requirements will only become more difficult. More chronic conditions will likely be scrutinized, and facilities need to show improvement each year - internally and nationally.
"Everyone else is getting better too," Bartingale noted.
To try to better gauge its progress throughout the year, the Fairmont hospital is holding monthly in-house reviews. The data so far looks good.
"We have good, reliable internal data," said patient safety specialist Christi Redenius.
From July 2011 to June 2012, there were 108 Medicare-eligible patients discharged from the hospital, of which, 23 were readmitted. For the following year, 19 of 110 patients were readmitted within 30 days.
"More discharges, fewer readmissions," Bartingale said.