Medicare Pilot Program Saves $1m And Reduces Readmissions

By Author: Ruskin Booth
Total Articles: 14
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A Medicare program to prevent expensive hospital readmissions has shown that there are millions of dollars in potential Medicare savings to be gained.

“The idea is to reduce preventable hospital readmissions for Medicare beneficiaries,” suggests Alan Weinstock, an insurance broker at MedicareSupplementPlans.com. “When the program began in 2009 nearly one in five patients who left the hospital was readmitted within 30 days. And over 75% of those readmissions were preventable.”

Success of Medicare Pilot Program

The pilot program began a year and a half ago with 14 communities nationwide and examined hospital readmission incidences locally with an eye on developing tailored solutions for preventing readmissions. The project relied on quality improvement organizations that contract with Medicare as well as local providers to help improve care.

In the Denver area program alone – one of the 14 communities involved – there was a 9.3 percent cut in readmissions among the study group of 80,000 Medicare beneficiaries in 44 ZIP codes.

The initial 14-city pilot program has saved approximately ...
... $100 million in Medicare hospital spending among about 1.25 million enrollees.

Overview of Medicare Pilot Program

The pilot program linked elderly hospital patients with transition coaches – nurses, social workers and family members – meant to help them coordinate drugs, physical therapy appointments, doctor follow-ups and home health care aids in order to prevent expensive and often dangerous hospital readmissions.

Medicare defines readmissions as returning to the hospital within 30 days of the initial admission. The coaching helped reduce new hospital admissions by eight percent during that 30 day period. The self-management skills that were taught to patients as part of the transition coaching helped them stay healthier overall, even when faced with another illness or accident.

“It’s like the saying about fishing,” notes Alan. “Give a man a fish, feed him for a day. Teach a man to fish, feed him for a life time. When you give people knowledge, you give them confidence in being able to help themselves.”

Recommendations for Coaching Medicare Beneficiaries

Assisting elderly patients, educating them on care after a hospital stay and coordinating their follow-up care has been shown to be an important factor in reducing hospital readmissions. Studies have shown that there are four basic tenets to helping reduce readmissions for Medicare beneficiaries:

1. Transition coaching which includes patient education, medication management, communication from health care providers and follow up;

2. Advanced care for seriously ill patients who are not hospice qualified;

3. Health coaching and pharmacy outreach;

4. Self-management classes for Medicare beneficiaries living with diabetes, lung conditions such as chronic obstructive pulmonary disease (COPD) and chronic pain.

Assisting Medicare beneficiaries is beneficial not only to them, but to the hospital and the health care givers involved in their care as well. Providing a better quality of life to Medicare beneficiaries and higher quality of care at a lower price offers big dividends to everyone involved.

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