In its first year, a program at Allegheny Valley Hospital in Natrona Heights has substantially reduced readmission rates for its sickest patients.
Allegheny Valley Chief Medical Officer Dr. Thomas McClure said the High-Risk Care Team (HRCT), created February 2012, singles out the patients who have the highest risk of returning to the hospital. McClure said the five team members do everything they can to ensure those high-risk patients don't have to come back for more treatment.
"They'll go into the patient's home multiple times in a day if they need to, or call them three or four times in a day," said McClure. "They arrange for transportation. They arrange for their medication to be delivered to them. Sometimes patients can't even afford their medications; they figure out a way to get those medicines to the patients, and for that to be paid for."
The HRCT looks after as many as 100 patients at any given time. From February 2012 to last month, the team is credited with reducing seven-day readmission rates by 30%, and cutting down 30-day readmission rates by 13%.
The HRCT was created for two reasons: first, because health insurer Highmark, which is buying AVH owner West Penn Allegheny Health System, asked the hospital to reduce its readmissions rates; and second, because the Affordable Care Act allows the federal government to withhold portions of a hospital's Medicare and Medicaid reimbursements if the facility's readmission rates are too high.
"I think all the hospitals thought, 'Well, we're handing [patients] off to a doctor or to a family, and now it's their care,'" said McClure. "We can't think in those ways anymore. We can't think in silos. It has to be a coordination of care across everything, and I think that's the whole idea behind the Affordable Care Act."
McClure said he'd like to see the out-of-hospital care program expand to include low-risk patients as well, in order to reduce readmissions even further.