Boston Hospital Tackles Readmission Problems

The BIDMC Post-Acute Care Transitions (PACT) program involves a team of nurses and pharmacists who see inpatients while they are still at the hospital, and then continue to check in, educate, problem-solve, and advocate for patients for 30 days postdischarge, by phone or sometimes in person. They work in conjunction with inpatient clinicians and case management staff at the hospital and continue to connect and share information with each patient's primary care physician, specialist, or other care team members.

The PACT program started as an internally funded pilot that grew after BIDMC received USD 4.9 million from the highly competitive first round of Center for Medicare and Medicaid Innovation Grants in May 2012 to launch a program designed to improve patient outcomes and prevent avoidable cost in the high-risk 30-day period following acute care hospitalization. So far BIDMC has reduced its readmission rate by 25%, which has the added advantage of reducing the approximately USD one million in federal fines levied on the hospital for having one of the highest rates of readmissions among Medicare patients in the United States.

“Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate. The hospital was providing quality care to patients when they were in the hospital, but it turned out that focus was too narrow,” said Julius Yang, MD, PhD, head of quality at BIDMC. “In the hospital we provide a lot of structure, we provide a lot of staff. We provide a lot of expertise to manage every moment of their illness; but as soon as they leave, the complexity of their situation probably explodes.”

“It is too soon to tell how PACT will impact readmission rates, but the program has resulted in a stronger voice for the patient, more and more specific information for caregivers, stronger discharge planning, and more informed patients and family members,” said Lauren Doctoroff, MD, PACT's medical director. “PACT definitely enriches the experience of the patient, and we know we are not sending patients out of the hospital without a parachute. The peace of mind for all involved is key.”

In 2013 Medicare levied fines of USD 227 million against 2,225 hospitals that will have payments reduced by up to 2% for a year. The penalty program, launched in 2012, was created to combat a perverse financial incentive where hospitals earned more money if patients' health deteriorates after they are discharged because they can be paid for two stays instead of one. The penalties are based on readmissions of Medicare patients who originally went into the hospital with at least one of three conditions—heart attack, heart failure, and pneumonia.

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