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News Roundup: November 30, 2012

Hospitals Offer Wide Array Of Services To Keep Patients From Needing To Return

Published by Kaiser Health News
Jordan Rau
November 30, 2012

In the past, the only thing a patient was sure to get after a hospital stay was a bill. But as Medicare cracks down on high readmission rates, hospitals are dispatching nurses, transportation, culturally specific diet tips, free medications and even bathroom scales to patients deemed at risk of relapsing.

Sue Koner, a transition care manager for Sun Health, checks Ted Cohn's blood pressure to try to prevent his readmission to a hospital for a heart condition (Photo by Joshua Lott for The New York Times/KHN).
Robert Wood Johnson University Hospital in New Brunswick, N.J., has nurses visit high-risk patients at their home within two days of leaving the hospital. Teresa De Peralta, a nurse practitioner who runs the program, said they frequently find that patients don’t realize a drug they were prescribed in the hospital does the same thing as one they have already been taking.

"When medications are changed, they don’t want to throw things out, they think it’s a waste," Ms. De Peralta said. "We actually go through the cupboards and painstakingly write out in big letters what they should be taking during the day."

Many hospital officials say their efforts to keep patients healthy after discharge have been spurred by new financial penalties Medicare started imposing in October on places with too many readmissions. Increasingly, hospitals are no longer leaving to patients the responsibility for setting up follow-up appointments or filling new prescriptions.

And hospitals are not assuming that personnel in nursing homes and other facilities know how to properly care for their patients and follow the hospital discharge instructions.

Patients taking the wrong dose or mixing medicines that react badly often end up back in the hospital. A survey of 377 elderly patients at Yale-New Haven Hospital, published this year in The Journal of General Internal Medicine, discovered that 81 percent of the patients either didn’t understand what all their prescriptions were for; were prescribed the wrong drug or the wrong dose; were taken off a drug they needed, or never picked up a new prescription.

Dr. Leora Horwitz, the study’s leader, said patients who were called a week after their discharge and were asked what changes to their medication they were supposed to make “overwhelmingly” couldn’t tell them.

A big part of reducing readmissions is making sure that patients understand early warning signs that their health is deteriorating. Sun Health Care Transitions, a foundation-supported program in Sun City, Ariz., gives scales to some patients with congestive heart failure because small weight gains indicate they are retaining water, a sign that their heart isn’t pumping adequately.

"We have them keep a log," said Jennifer Drago, a Sun Health vice president. "We want them to be looking for a two-pound daily weight gain, or five pounds over the week."

Patients whose weight creeps up are quickly sent back to their doctor. Debra Richards, director of case management at Banner Del E. Webb Medical Center, one of the hospitals Sun Health is assisting, said, "That program has helped us quite a bit."

Shady Grove Adventist Hospital in Rockville, Md., has started taking patients’ cultural backgrounds into consideration when doling out advice about maintaining their health. For example, the hospital encourages Salvadoran patients to substitute olive oils for the palm oils their cuisine traditionally calls for, to roast or bake meat instead of frying it and to use sugar substitutes when making horchata, a popular Central American drink.

When Hackensack University Medical Center sent staff members to teach caregivers how to take care of their patients, one place "didn't even know what a low-salt diet was," even though that's a critical part of keeping heart failure patients from retaining fluids, said Dr. Charles Riccobono, chief quality and safety officer at the New Jersey hospital.

Aurora Health Care, a Milwaukee-based health system, now places its own nurse practitioners in several nursing homes to watch over Aurora's discharged patients. Aurora says readmission rates of those patients have decreased, in some months by as much as half.

Dr. Eric Coleman, a Denver geriatrician whose ideas on reducing readmissions have been adopted by a number of hospitals and Medicare, said that while some hospital changes are "exciting and new," others are "relabeling old wine in new bottles."

"Yesterday we had 'discharge planning' and today we have a 'rapid response transition team,' and content-wise they're doing the same thing," Dr. Coleman said. "But it’s a nice thing to report out to the board of trustees."

Remote monitoring to cut readmissions by 75%

Published by Fierce Healthcare
November 30, 2012

A pilot program at Central Indiana Beacon Community that focuses on remote video conferencing between nurses and discharged hospital patients cut readmissions by a dramatic 75 percent, according to Alan Snell (pictured), chief medical informatics officer at Indianapolis-based St. Vincent Health and panel speaker at the upcoming FierceMobileHealthcare breakfast roundtable on Dec. 4 at the mHealth Summit. Seven St. Vincent's hospitals and seven partner hospitals participated in the program with 300 patients who were being discharged with diagnoses of congestive heart failure and chronic obstructive pulmonary disease.

"We went after patients that were in capitated populations our self-insured, employed population for the hospital and their dependents so that we could establish baselines on their cost of care before and during the monitoring," he said. "We're finding some pretty dramatic drops in that cost of care."

For instance, a patient with 13 admissions for CHF last year cost St. Vincent's health plan $156,000, but with 11 months of monitoring, she had no admissions.

Read more: Remote monitoring to cut readmissions by 75% - FierceHealthcare

Dem leaders: Cuts to Medicare benefits off the table in deficit negotiations

Published by The Hill
Mike Lillis
November 30, 2012

Democratic party leaders on Wednesday argued that they had already put Medicare cuts on the table in deficit talks, but they ruled out any reduction to benefits.

"Is Medicare – has it been on the table? Absolutely it has been on the table," Rep. Xavier Becerra (Calif.), the vice chairman of the House Democratic Caucus, said Wednesday following a caucus meeting in the Capitol with senior White House economic adviser Gene Sperling.

"We're willing to talk and to put everything on the table for discussion — at least this Democrat is," Becerra said. "But the moment you want to privatize Social Security, or voucherize Medicare, or block-grant Medicaid — that's where you lose us. Because we want to strengthen those programs, not let them die on the vine."

Rep. John Larson (D-Conn.), who heads the House Democratic Caucus, echoed that message, claiming there's more than $700 billion in savings to be had by ironing out inefficiencies in the healthcare system that wouldn't affect direct benefits. He suggested fixing those problems shouldn't be a partisan issue.

"I do not believe that Republicans want to see their beneficiaries, their recipients in their communities, lose their benefits," Larson said. "So I think there is a common ground for us to work under."

The remarks come as the bipartisan fiscal-cliff talks are beginning in earnest and both sides say they're eager to get a deal.

Still, while leaders of both parties have publicly adopted a more conciliatory tone since the Nov. 6 elections, neither side has been willing to cede any ground on their core policy positions. Democrats are still insisting there be no cuts to entitlement benefits — something GOP leaders are urging. And Republicans are demanding there be no increase in marginal tax rates while Obama and the Democrats are insisting on raising rates for the wealthy.

Republicans say they are willing to accept more tax revenue, but only from eliminating loopholes and deductions in the tax code.

Larson on Wednesday suggested the GOP's offer is insincere.

"Clearly, as Gene Sperling was saying today, the president's willing to look at what they're going to put forward in terms of revenues," Larson said. "But that hasn't been forthcoming, shall we say.

"But where the president's been very clear is in terms of the impact on beneficiaries," he added.

Becerra noted that the looming automatic budget cuts include Medicare spending but not Medicare benefit payments.

"We've been smart, at least on the Democratic side, in how we go about it," Becerra said. "We don't go after benefits for those who've earned them. We try to make sure that we get rid of the waste and the overspending by those who are profiting from Medicare. And you can do that."

The Democratic leaders also pushed back against proposals to make Social Security a part of the fiscal-cliff talks.

Social Security, Larson said, "is not responsible for the deficit and clearly shouldn't be on the table for discussion."

Becerra had a different take. He said everything should be on the table initially, but those programs that don't contribute to the deficit should be taken off the table quickly. Social Security, he said, is one such program.

"Everything should be on the table, period," Becerra said. "And if we're smart and sensible, we'll leave on the table to help us reduce our deficit the things that drove us into these deficits.

"Why [you would] cut the benefits of seniors on Social Security to pay for the misspending and the bad ideas of previous Congresses, I don't understand," he said.

New Technology Allows Seniors to Age at Home and Stay Connected

Published by Home Health Care News
Jason Olivia
November 30, 2012

For some seniors, receiving long term care at home is being made easier by the release of new technology. Today, one more tool went online to help older people age in the comfort of home.

The latest from the Los Angeles-based company LivHOME’s, CareMonitor keeps seniors up to date on personal health matters without having to foot the costs of hands-on-care.

LivHOME CareMonitor is a web-based, touch-screen service powered by GrandCare Systems that enables seniors to relay data to professional care providers remotely.

Through monitors located on arms and fingers, seniors are able to check blood pressure and oxygen levels, along with glucose and bodyweight readings via Bluetooth technology. The CareMonitor can even track medication schedules and movements around the house.

LivHOME is confident that its easy-to-use technology will appeal to an increasing number of seniors looking to remain independent and receive care in the privacy of their own homes.

Part of the CareMonitor’s allure, LivHOME CEO Mike Nicholson suggests, is that it will extend caregiving services to a new senior demographic of those who benefit from some assistance but do not require a full-time caregiver.

“LivHOME CareMonitor represents an entirely new approach to caregiving, enabling us to monitor the health and safety of our clients—but without the intrusiveness or cost of hands-on-care,” said Nicholson. “This provides greater independence and privacy, while significantly reducing the cost of care.”

Other features of the LivHOME CareMonitor include professional care manager assessment; personal emergency response system; 24/7 alert monitoring and care manager availability; media connectivity for music, photos, messages and Skype.

One of the nation’s largest providers of professionally led at-home care for seniors, Nicholson notes that LivHOME was one of the first companies to place caregiver supervision under a professional care manager’s responsibility in 1999. Thirteen years later, the company continues making innovations toward senior home care with its development of the remote CareMonitor.

First announced in March, LivHOME is beginning to roll out its CareMonitor nationwide in late 2012 and early 2013.