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Danville – For years, hospitals and skilled nursing centers have existed in separate realms, with patients floating back and forth between the two, often with little coordination of care to improve the health of the patient. Even with both hospitals and nursing facilities making their best efforts, patients all too often fell through the cracks. In fact, in 2011, the Medicare Payment Advisory Committee reported to Congress that as many as 18 percent of Medicare patients in central Indiana were re-hospitalized within 30 days of a hospital discharge.
Medicare has set in motion new standards that have encouraged hospitals to take an active role in preventing readmissions of elderly patients after they have been discharged from the hospital. By working together to improve care, hospitals and nursing facilities are now putting the patient’s health and quality of life at the forefront.
Hendricks Regional Health, local nursing facilities, and a medical group known as
Acute Rehab Medicine Specialists (ARMS), have partnered on such efforts and shown that care for sick seniors can be dramatically improved. For Hendricks Regional Health, this has resulted in a drop in 30 day re-admission rates from 6.3 percent in 2011 to 4.5 percent through 2013. While many hospitals have reduced re-admissions during this same period, the benchmark from the Healthcare Research and Education Trust places the average rate at 8.5 percent.
ARMS was created to bridge the previous gap between hospital care and nursing facility care. Hendricks Regional Health has developed a close working relationship with ARMS; several of the physicians on the ARMS medical staff are also employed by Hendricks Regional Health as hospitalists (physicians who specialize in the care of hospitalized patients) or in other medical specialties. These physicians work directly with patients and caregivers at five nursing facilities in Hendricks County. As an independent medical practice, ARMS focuses on providing coordinated, high quality care for nursing facility patients who have had a recent hospitalization. Frequent physician visits with these patients and efforts to increase physician/nursing communication at the facilities has resulted in improved health and shorter length of stay for short-term nursing center patients, as well as reducing the number of re-admissions.
With Medicare, Medicaid and other insurance companies covering fewer days in the hospital, patients are being released from hospitals sooner than they were a decade ago. These earlier releases have resulted in sicker patients being received by nursing/rehabilitation facilities. If those patients experience complications and require a readmission to the hospital within 30 days, the discharging hospital is penalized by Medicare with a cut in reimbursement rates. Under this new arrangement, it is in the best interest of the hospital to ensure that each patient has a good outcome and does not end up back in the hospital.
Good continuity of care is the first step in ensuring improved quality at skilled nursing centers. Hendricks Regional Health is able to extend care beyond its own walls through the capable hands of the ARMS physicians; that extension of care means improved quality and better outcomes for patients. The additional attention to their medical needs helps ARMS patients recover faster, in a safer environment. At any one time, approximately 25 percent of nursing center patients are only staying short-term while recovering from surgery or illness. The national average for short-term stays in nursing facilities is 27 days; with more frequent visits by a physician, ARMS patients staying short-term go home in an average of 22 days.