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News Roundup: February 18, 2013

No strong link between readmissions, mortality: study

Published by Modern Healthcare
February 14, 2013


Researchers have failed to find evidence of a strong link between hospital readmission rates and mortality rates, calling into question concerns that the two might be inversely related.

For the study, which appeared in the Journal of the American Medical Association, researchers examined three years of Medicare data, assessing 30-day readmission and mortality rates among patients hospitalized with heart attack, pneumonia and heart failure. They found no relationship between readmissions and mortality for heart attack and pneumonia patients and only a weak association for heart failure patients.

A number of researchers and policy experts have suggested recently that hospitals with lower mortality rates could, as a result, have higher readmission rates. One reason, they say, is because very sick patients who are kept alive are then eligible to be readmitted.

The authors of this latest study, including Dr. Harlan Krumholz, a professor of cardiology at Yale University, New Haven, Conn., argued instead that CMS data reveals no such relationship.

“These findings should allay concerns that institutions with good performance on (risk-standardized mortality rates) will necessarily be identified as poor performers on their (risk-standardized readmission rates),” the authors wrote in the study, adding that they had identified high and low performers on readmissions at all levels of mortality.

“Our findings indicate that many institutions do well on mortality and readmission and that performance on one does not dictate performance on the other,” they wrote.

Navigating Hospital-To-Home Care Transitions

Published by QMedic
February 14, 2013

Moving a loved one from the hospital back to their home can be a difficult transition for family caregivers. When these transitions are not properly planned and managed, the patient often ends up back in the hospital. Approximately 20% of Medicare patients are readmitted to the hospital within 30 days of discharge and up to 75% of these readmissions are preventable according to the Agency for Healthcare Research & Quality.

Recent studies released by the Journal of the American Medical Association have identified poor care transitions from hospital to home as one of the primary causes of high hospital readmission rates. One of the biggest challenges in care transitions is that family members, often with limited caregiving training or experience, are suddenly asked to manage their loved one's care. This is very common as up to 80% of all chronic disease care is provided by family members.

What are some things that a family caregiver should keep in mind to create a smooth transition from hospital to home? Here are a few ideas based on suggestions from Medicare, AARP and nextstepincare.org:
Understand your loved one’s condition: In a recent study at Yale, only 57% of patients knew their diagnosis. Both the patient and the loved one should work with doctors and nurses to understand the patient’s condition. This way you know what your loved one’s limitations will be and if there are certain symptoms that you should be reporting to a health care professional right away. A good transition plan must start with a strong understanding of the patient’s condition and needs.
Pay special attention to medication: The population that is most at risk for readmission is those that take more than 5 medications. As the amount of medication prescribed increases, compliance decreases. If your loved one takes multiple medications, make sure that you have a plan to help him or her take the right dose of the right medicine at the right time. Also, understand the potential adverse effects of medication. The same Yale study mentioned above found that 90% of patients did not know the possible adverse effects of medications.
Establish communication lines: Make sure you have the contact information for doctors, pharmacists, in-home care providers and others involved in your loved one’s care.
Bring in help when necessary: In-home care providers can provide critical support during transitions. Geriatric care managers can help you navigate the variety of decisions you will have to make and serve as an advocate. It’s a stressful time for many family caregivers and doing it alone can be very difficult.
Home Modification & Equipment: If necessary, find a service provider to modify the home so your loved one can live comfortably and safely. This article gives you some ideas of the modifications you might want to make. Based on your loved one’s condition, explore different technology solutions that can help him or her stay connected to friends, family and health care providers.
Here are some good checklists, guides and tips as you prepare for your loved one’s transition from the hospital to home:

Obama Addresses Raising Minimum Wage, Indirect Impact for Home Care Workers

Published by Home Health Care News
Alyssa Gerace
February 13, 2013

President Obama advocated for higher federal minimum wages in last night’s State of the Union address, but proposed rules for the Fair Labor Standards Act to extend to home care workers must first be implemented for higher wage requirements to have a direct impact on personal care aides and home health aides.

“Tonight, let’s declare that, in the wealthiest nation on Earth, no one who works full time should have to live in poverty—and raise the federal minimum wage to $9 an hour,” the president said. While the current federal minimum wage is $7.25, 19 states have chosen to institute higher wages since the last time the federal rate was raised by Congress, he continued.

It was “terrific” that the president announced raising the minimum wage as an objective in the State of the Union address, says Steve Edelstein, national policy director at PHI (Paraprofessional Healthcare Institute), but there’s an important step that’s missing for a direct impact on home care workers.

“The one irony is that, for direct care workers in the home and community, the home care workforce isn’t subject to federal minimum wage or overtime wage protection,” he says.

However, if all other wages are going up, it’s expected that home care workers’ employers would have to follow suit, he says, and wages would go up due to labor market dynamics.

In December 2011, the Department of Labor proposed rules extending the Fair Labor Standards Act (FLSA) for minimum wage and overtime protection to home care workers. The public comment period that lasted throughout the spring of 2012 garnered about 25,000 comments—three-quarters of which were in favor of the proposed rule, according to Edelstein.

“It generated a lot of interest, and a lot of folks weighed in on behalf of these workers, who are critical to providing home- and community-based services,” he says. The rules have now gone to the Office of Management and Budget for review and are working their way through the regulatory process.

In 2011, the national median wage for personal care aides was $9.49, representing a less-than-1% increase from the previous year. In a 10-year period between 2001 and 2011, 41 states showed a decline in “real” median wages for PCAs, after adjusting for inflation.

Those numbers are averages, Edelstein emphasized, so for those whose wages track the federal minimum wage, some would see an increase.

“The economic security of hundreds of thousands of caregivers who make it possible for others to live independently is at stake,” said Dorie Seavey, PHI director of policy research, when the analysis was released. “It will be very difficult for our country to meet the rapidly growing demand for personal assistance workers without improving these wages.”

Personal care aides belong to the fourth fastest-growing occupation in the nation, according to PHI, as the nation’s 65+ demographic is expected to comprise about 20% of the overall population by 2050.

“We know our economy’s stronger when we reward an honest day’s work with honest wages. But today, a full-time worker making the minimum wage earns $14,500 a year,” said Obama during his speech. “Even with the tax relief we’ve put in place, a family with two kids that earns the minimum wage still lives below the poverty line. That’s wrong.”

WSJ: House Calls Make Comeback as Hospitals Face Readmission Pressure

Published by Home Health Care News
Jason Olivia
February 11, 2013

Health care providers are bringing back the house call as a way to keep patients out of the hospital, while also avoiding Medicare reimbursement penalties.

The latest in the ongoing efforts to reduce re-hospitalizations, the Wall Street Journal (WSJ) reports that providers are sending teams of doctors, nurses, physician assistants and pharmacists to treat frail patients living at home.

The transfer of medical services to patients’ residences have some adopting programs called “Hospital at Home,” in which provides an array of tests such as ultrasounds, x-rays, and even electrocardiograms.

Since last October, Medicare began issuing 1% reimbursement cuts to hospitals with higher-than-expected readmission rates.

Having much of the blame for patient re-hospitalization fall on their shoulders, hospitals have been accused by Medicare for inattentive care toward patients once they have been discharged, many of which end up back in the hospital for the same conditions within 30 days post-discharge.

By treating patients at home, providers are taking steps toward easing the transitional period for individuals as they move from institutions to home.

As for costs, WSJ reports that the payment models vary, with one method being private insurers can contract with Medicare to offer benefits through home-based care plans.

The revamping of house calls has already scored well among patient satisfaction, writes WSJ, as many individuals are more comfortable receiving care in their own homes as opposed to institutional settings.

A study published by Health Affairs in June also showed that costs for patients in the Hospital at Home program were 19% lower than similar patients in hospital settings. Reasons for which were attributed to fewer lab and test costs.

Transitional care programs like Hospital at Home have already started yielding improvements.

A not-for-profit health system in Cincinnati, Mercy Health was able to reduce its 30-day readmission rate from 16.9% in 2011 to 14.5% in November, using a transitional care program that assigned nurses to high-risk patients, according to WSJ.

Positive results are also reverberating among insurers, like Aetna, who is currently contracting with home health agencies to expand transitional care programs for beneficiaries of its Medicare Advantage plan.

Providing care to patients in the comfort of their own homes, while reducing the risk of re-hospitalization and increased Medicare penalization, transitional care models such as the Hospital at Home program might be the collaboration the industry has been waiting for between hospitals and providers.