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Published in CenterView on November 05, 2012
Dr. John Wofford, left, associate professor of medicine, discusses a patient’s discharge orders with Dr. Michael Baumann, chief quality officer.
Dr. John Wofford, left, associate professor of medicine, discusses a patient’s discharge orders with Dr. Michael Baumann, chief quality officer.

UMMC’s 30-day readmission rates meet CMS’ ‘cost-neutral’ standards, reflect quality efforts

By Bruce Coleman

Recent media scrutiny of the potential impact of the federal government’s Hospital Readmissions Reduction Program on Mississippi hospitals has shined a spotlight on 30-day readmission rates for Medicare patients throughout the state.

A provision of the Patient Protection and Affordable Care Act, the quality improvement initiative launched last month assigns financial penalties to hospitals whose 30-day Medicare readmission rates for heart failure, heart attack and pneumonia are higher than the national average.

Despite being the safety net hospital in a state with some of the most daunting health-care challenges in the country, the University of Mississippi Medical Center’s readmission rates were in alignment with national averages and the institution was not subject to any readmissions penalties from the federal Centers for Medicare and Medicaid Services (CMS), according to Dr. Michael Baumann, professor of medicine and chief quality officer.

“We’re very happy we ended up in the cost-neutral category,” he said. “The measure assesses how much you exceeded or were under a certain rate compared to many other hospitals.

“We have a challenging mix of patients, but so do a lot of other hospitals throughout the country.”

Baumann said the favorable results might be attributed to patient communication efforts by hospitalists – physicians who care for patients while they are hospitalized – and UMMC cardiologists.

“The hospitalists get roughly half of the heart failure patients and they are consistently working on this,” Baumann said. “They have a program where they have after-discharge contact with all of their patients, including those who fall under the three categories that are being measured.

“Cardiologists have put a lot of effort into making sure their patients with acute myocardial infarction and heart failure take their medication and have their follow-up clinic appointments.”

For an institution with a patient base comprised of approximately 60-65-percent Medicaid or self-pay patients, the results are most impressive, according to Baumann.

“Our patient mix in general is often a bit more challenging, given the socioeconomic issues that our patients have to deal with,” he said. “They often may not have easy access to transportation, they may not be able to afford their medications and the educational level of a lot of our patients may make it difficult for them to understand their discharge instructions.”

Baumann said another challenge is that, with a few appropriate exceptions such as planned chemotherapy, patients can return to the hospital for a completely unrelated reason than their initial visit and that admission counts “against us.”

“The measure we are being assessed by looks at all readmissions within the next 30 days whether the readmission is related to the original reason for hospitalization or not,” he said. “For example, somebody initially showed up with a heart attack, then shows up two weeks later after developing pneumonia that wasn’t there during their first visit.

“That can be a real problem.” 

Despite the Medical Center’s good quality rating, Baumann said hospital administrators are taking a renewed focus on readmission rates at UMMC – and not just in the three categories being measured by CMS.

“Even though CMS is focusing on heart failure, pneumonia and myocardial infarction, we’re going to be looking at how we deal with 30-day readmissions across the board for all our patients,” he said. “We’re having a presentation from an outside vendor to get leadership thinking about a systematic approach to grappling with 30-day discharges.”

The remaining challenge will be for UMMC to maintain its 30-day readmission standards so the institution can avoid any future penalties.

“We always need to be looking at what we can do better so patients don’t have to come back to the hospital,” Baumann said. “This is just the right thing to be doing for our patients. We want to get it right the first time.”