NewburyportNews.com, Newburyport, MA

October 10, 2012

Clarifying rules on hospital admissions


Newburyport Daily News

---- — To the editor:

In a letter dated Sept. 21, a gentleman expressed concern about the health care needs of his wife. He thought changes in Medicare payments would restrict her from being readmitted to the hospital within 30 days of discharge if she was sick again with the same diagnosis. For this caregiver and others, there is anxiety that health care services will be denied. But this is not what the new rules intend.

Beginning Oct. 1, Medicare reduced payment to hospitals for preventable admissions within 30 days. The operative word is preventable, meaning the admission could have been avoided. If it is determined the admission was preventable, the hospital will receive a reduced reimbursement. But that does not mean caregivers or patients should stay home and not get the care they need.

The purpose of these changes is to enhance the discharge planning and transitional care provided to patients between care settings. Elder Services of the Merrimack Valley, Inc., Anna Jaques Hospital and five other Merrimack Valley hospitals have begun a joint venture to assist in the reduction of preventable re-admissions within 30 days. The Transitional Care Program provides trained coaches to work with hospital staff at the time of patient discharge to insure a smooth transition home. Once home, the coach works with the patient, family or caregivers to access the medical services and support a patient needs, and works with health care providers to coordinate services for the patient and family.

Not all readmissions are preventable, particularly in cases where the patient is medically compromised. But a collaborative approach to manage care both inside and outside the hospital walls insures services are seamless and comprehensive. This model proved successful in evidenced-based research, helping prevent avoidable readmissions for some patients, and increasing the active participation of patients in their care the next time they faced a health care crisis.

The Transitional Care Program is expected to save Medicare dollars through better care planning, patient education and service interventions to help prevent a medical crisis. The goal is to inform patients and actively engage them in their health care needs and decisions.

The letter on Sept. 21st ended with three questions.

1. Was his description of the change in the law accurate? No.

2. What is a person with life-threatening emergencies expected to do? Call 911, go to the hospital and let medical professionals determine the best course of action.

3. Does this affect only those over 80 and 90? No.

We are sorry the reader was caused concern about his wife’s care. We hope this letter helps to clarify the change, and to insure patients understand the purpose and goals of local hospitals and community agencies working together. Please call Elder Services at 1-800-892-0890 if you have other questions about this program or other community care options.

Rosanne J. DiStefano

Executive director

Lori O’Connor, R.N.

Director

Community Transitions Program

Elder Services of the Merrimack Valley, Inc.