Reimbursement trends
In a recent study conducted by Beth Israel Deaconess Medical and Harvard Medical School, which looked at heart attack readmissions, the findings revealed that although reductions in readmissions have been attributed to improvements in discharge planning and care transitions, these declines may instead be due to hospitals and clinicians intensifying efforts to treat patients who return to a hospital within 30 days of discharge in emergency departments and as observation stays.
The study suggested that financial penalties imposed by HRRP may have inadvertently pushed some physicians to avoid readmitting patients who needed hospital care, or potentially diverted hospital resources and efforts away from other quality improvement initiatives.
Based on the results of Boyd’s study, the authors recommend that policy makers may want to consider if readmission penalties are sufficient, examine how patient care can be improved, and make sure that type of ownership does not impact care quality.
Chetan Khamare, MD, cardiologist at the Premier Heart and Vascular Center in Zephyrhills, Florida, says the center is seeing a 2.9% net increase in 2019, compared to 2018, for heart attack and CABG. However, for readmissions there is a 3% penalty for excess readmissions for CHF, acute MI, and CABG.
Managing risk factors to drive down 30-Day readmissions
To drive down 30-day readmissions, the Premier Heart and Vascular Center has: increased education around the importance of diet, exercise, and medication compliance at discharge; schedules a follow-up appointment in the office prior to discharge; provides a home health RN to visit the patient after discharge; and calls patients after discharge to ensure they have answers to any questions about medications and symptoms.
“We also assign a nurse navigator to follow up with the patient,” Khamare says. “And we have implemented immediate physician specialty consultation in the emergency department to determine if readmission is necessary.”
This strategy has helped drive down readmissions by as much as 5% this year.
“We have been effective in decreasing readmissions rates; however, more work needs to be done,” he says. “This is a work in progress.”
Sinatra’s biggest personal successes with patients with all these heart issues came with pairing conventional treatments with a “metabolic cardiology” protocol: CoQ10, D-ribose, L-carnitine, and magnesium, as well as omega-3s (fish oils). This combination of nutrients was instrumental in helping to prevent arterial reclosure and plaque rupture in his patients.
In an August 2019 study published in the Annals of Internal Medicine, researchers looked at 41 studies with a total of 134,034 participants to evaluate the effectiveness of omega-3 supplements. What they found is that omega-3 supplement use was correlated with an 8% reduction in heart attack risk and a 7% reduction in coronary artery disease when compared with the non-supplement group.
Another study conducted at Carnegie Mellon University showed that optimism is an extremely important healer. In their conclusion, they found that “Optimism predicts a lower rate of rehospitalization after coronary artery bypass graft surgery [and] fostering positive expectations may promote better recovery.”
“An often hidden risk factor in hospital readmissions is emotions—which can put patients into fight-or-flight mode and precipitate a cardiac event,” Sinatra says. “A lot of my patients needed to be counseled. I would tell them they needed to let the situation go—it’s not worth dying for.”
Related article: How Health Systems Use Pharmacists to Reduce Readmissions
Nicholas Hamm is an editor with Managed
