The Affordable Care Act included a readmissions provision that imposes financial penalties on hospitals for “excess” readmissions when compared to “expected” levels of readmissions. This penalty program will be imposed on hospitals beginning October 1, 2012 based on discharges occurring during the three-year period of July 1, 2008 to June 30, 2011. The initial payment penalties are based on the 30-day readmission measures for heart attack, heart failure and pneumonia that are currently part of the Medicare pay-for-reporting program. Pen Bay Medical Center is one of the 2,211 hospitals that will receive a penalty. The dollar amount of our penalty will be $77,590, which is less than one tenth of one percent of our total Net Revenue.
Preventing readmissions is a system-wide if not community-wide issue that involves hospitals, physicians, and other providers who manage patient care. Pen Bay Medical Center is committed to improving quality of care for all patients. Under our partnership care initiative, we are involving patients and their families as full partners in decisions about their care. Our system wide Continuity of Care team has been working on collaborative processes in order to optimize patients’ and families’ decisions and preferences as they transition from the hospital to the home or other venues.
One of the main elements of care that has been instituted to reduce our readmissions, where appropriate, is a risk assessment that is conducted when the patient is admitted to the hospital. Based on the results of this risk assessment, interventions happen during the hospitalization and at discharge. These interventions may include: a visit with a nurse transition coach, home health visits, follow up phone calls, medication education, follow up visits with the primary care physician and connecting the patient with our area agency on aging, among other interventions. As one can see from the network of agencies and folks involved in the continuity of a patient’s care, reducing readmission is not only a hospital mission, but a community-wide mission. There are times when a return to the hospital is most appropriate.
There are many variables related to patients’ care after they are discharged. Pen Bay Medical Center continues to be committed to improving quality of care and providing all patients with the right care at the right time in the right setting.
Paula Delahanty, RN, BSN, MHSA
Vice President of Nursing Services
Pen Bay Medical Center