A report released earlier this month by the federal Centers for Medicare and Medicaid Services (CMS) indicates that Beaufort Memorial Hospital will be sharply penalized for hospital readmissions at rates higher than the national average from July 2012 through June 2015.
But the report of the penalty fails to tell the whole story.
The Hospital Readmissions Reduction Program requires CMS to track readmission of Medicare patients within 30 days of their discharge for six conditions. Among them are heart attack, heart failure and pneumonia.
For three of the five conditions applicable to Beaufort Memorial patients, readmission rates were below the national average; for a fourth — pneumonia — they were 0.1 percent above. It was only rates for hip and knee replacement patients that more notably exceeded the average.
Of the 619 Medicare patients who received replacement hips and knees during the period reported on, 40 were readmitted to Beaufort Memorial or another hospital.
The reasons for their readmission varied widely. Some were related to their replacement surgery, but many were not.
Important to note is that under the Hospital Readmissions Reduction Program, readmission of a Medicare patient originally hospitalized for one of the six conditions to any hospital for any condition is considered a readmission to the original hospital.
For example, a patient who received a knee replacement at Beaufort Memorial on March 3 and was injured in a car accident in Jacksonville and admitted to a hospital there on March 24 would be counted as a Beaufort Memorial readmission.
As for those Medicare patients readmitted to the hospital for a condition related to their hip or knee replacement at Beaufort Memorial, readmission should not be confused with poor outcome. Indeed, in readmitting patients, doctors frequently exercised what one termed “an abundance of caution” to ensure good outcomes.
Supporting such outcomes is the Beaufort Memorial Joint Replacement Center’s high patient satisfaction rate. Almost unanimously patients surveyed report they would return to the center for another procedure should they need it, commending the center’s dedicated team of professionals for excellent, well-coordinated care.
And The Joint Commission has recognized the center with its disease-specific certification for total hip and total knee replacement, a gold standard.
Thanks to comprehensive, multidisciplinary efforts in recent years to improve or enhance every aspect of the Joint Replacement Center’s patient experience, best practices are now in place that ensure early identification and quick resolution of any problem that may arise post-surgery, significantly reducing the need for hospital readmission.
Joint replacement patients leave the hospital with a list of numbers to call day or night with questions or concerns, no matter how small, related to their procedure. Included are numbers for the center’s nurses station and its orthopaedic care coordinator.
Once home, patients are carefully monitored. They receive a check-in call from the hospital within 24 to 48 hours and see their surgeon for a follow-up visit in one to two weeks. In addition, they begin intensive at-home or outpatient physical therapy a day or two after discharge. Thus they are evaluated by a health care professional multiple times weekly for at least the first two weeks.
Reducing readmission rates for all patients remains an essential goal for Beaufort Memorial, and one toward which real progress has been made. For 2015, the hospital’s overall readmission rates were well below the national average.
But paramount to us at Beaufort Memorial is, and always has been, advocating for our patients and addressing their needs. Though reimbursement systems may change, our commitment to doing right by those in our care never will.
Kurt Gambla is vice president and chief medical officer of Beaufort Memorial Hospital.