Mount Sinai Hospital Reduces Patient Readmissions Thanks to Obamacare Initiatives

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HRA-thumb7Mount Sinai Hospital in New York used to be like many other hospitals in the United States, writes Shannon Pettypiece over at Bloomberg, with high patient readmission rates and customers who would be hospitalized and rehospitalized multiple times over a few months.

That is, until the Affordable Care Act provided financial incentives (or penalties) for reducing (or exceeding) readmission rates.

According to the article, “Mount Sinai said the program reduced admissions 43 percent and cut emergency-room visits 54 percent during a test run from September 2010 to May 2012. The decision to target high-risk patients is estimated to have saved $1.6 million in medical costs over a six-month period, the hospital said.”

Feedback from its patients has been positive, with one saying “the program may have saved her life.”

With the HIEs gobbling up many of the healthcare-related headlines, it’s important to remember insurance is only one part of Obamacare. Reducing patient readmissions is a significant driving force behind the bill’s momentum. Federal estimates show that accountable-care programs could save upwards of $1.9 billion from 2012 until 2015. As one expert pointed out, healthcare reform is about more than just cost containment; it’s about transforming the delivery of care.

And yes, evaluating a patient’s impact on the bottom line is part of this accountability. In fact, Pettypiece writes, Mount Sinai “administrators begin each morning by making a list of those patients most likely to hurt the hospital’s bottom line. Using a multimillion-dollar computer system and complex algorithms, they score how likely each patient in the hospital is to be readmitted based on a rage of factors, such as medical history and recent admissions.”

It’s not hard to image the wild conclusions Glenn Beck would draw from this about the (most certainly) doomed future of the United States, but this seemingly crass crunching of numbers is leading to more compassionate, patient-oriented care at Mount Sinai, the article relates.

Immediately after those numbers are crunched, social workers are given the results. The social workers then “make contact with the patients determined to be most at risk. A social worker then spends 75 minutes meeting with each patient, trying to tease out issues that may result in a round-trip back to the hospital.”

75 minutes.

That’s an incredible investment of time for any organization, but Preventable Admissions Care Team program director Maria Basso Lipani said: “We are looking for the underlying reason that people are coming back to the hospital.

“We really will do anything and everything.”

Furthermore, Pettypiece continues, “Mount Sinai has a special program for its most at-risk patients to enable them to get easy access to a regular doctor or nurse practitioner, which many low-income patients struggle to find.”

This access is open to patients 24/7. The physician or NP helps them sort out the nature of the medical emergency and if that patient needs to go to the ER or set up a doctor’s appointment. Such a personalized approach not only improves a patient’s health, but also boosts their morale and their sense of self-worth.

“While the work isn’t cheap or easy, Mount Sinai said the efforts are worth it,” Pettypiece writes. “Based on the initial results, the hospital received a five-year grant from the federal government to pay for 20 social workers focused on patients in Medicare, the U.S. government’s health plan for the elderly and disabled. In addition, insurer HealthFirst pays for three social workers to help keep its members healthy, and the hospital pays for four more to target patients with Medicaid and private insurance.”

As healthcare executives, how are you working to reduce your patient readmissions? Have you taken a more personalized approach to individual patients? What improvements have you seen?

-by Pete Fernbaugh

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