San Antonio Hospital Systems

Nix Health beats national average for re-admittance…

Report raps S.A. hospital systems
By Don Finley

With Medicare planning to penalize hospitals whose patients return to the hospital soon after they’re discharged, San Antonio hospitals appear to have plenty of room for improvement. Most fared worse than the national average, according to a new report released Tuesday by the Dartmouth Atlas Project, which tracks differences in medical care throughout the country. “Often times hospitals have seen their responsibility as ending when a patient leaves the door, and have made minimal efforts in terms of coordinating care or communicating to community physicians,” said Dr. David Goodman with the Dartmouth Institute for Health Policy and Clinical Practice. “The result is that readmission to the hospital is a fairly common phenomenon, occurring in one out of six (Medicare) patients.”

The federal government says avoidable re-admissions add $17 billion a year to Medicare costs. And so starting in 2013, hospitals with excessive numbers will be penalized 1 percent of their total Medicare billings. That penalty will rise to 3 percent by 2015. Goodman said hospitals can improve their scores by working closely with patients, families and family doctors after discharge, to make sure patients take the correct dose of medicines and they receive outpatient care from a doctor or nurse practitioner within two weeks.

In 2009, the most recent year data was available, only Nix Health — which includes the Nix Medical Center downtown and several satellite facilities — had better readmission rates than the national average. At the Nix, 14 percent of medical patients were readmitted within 30 days of discharge, compared with 16.1 percent nationwide. Only 8.4 percent of surgery patients were readmitted, compared with 12.7 percent nationwide. “We have multisystem specialists who work together in an unfragmented way, and it is this defragmented care that extends throughout our organization,” said Adele Giles, senior vice president and chief of quality and compliance at Nix. “In addition, the team caring for our patients ensures discharge instructions are properly communicated and arrangements for follow-up care are made.”

The worst numbers locally belonged to TexSan Heart Hospital, with 19.8 percent of medical patients and 13.6 percent of surgical patients readmitted within 30 days. Those rates were recorded before Methodist Healthcare System bought the hospital in January. To reduce re-admissions, the Methodist system provides patients and families with both written and verbal instructions when they leave, said spokeswoman JoAnn King. And within 48 hours, a registered nurse calls them at home. “We ask if they have filled the prescriptions they received upon discharge and ask if they have any questions about their discharge instructions. The nurse encourages them to follow up with their physician and we provide a physician referral if they need one.” Seeing a doctor within two weeks of discharge also can reduce the odds of readmission. Nationally, 42.9 percent of patients visited a primary care doctor within two weeks. In San Antonio, that rate ranged from 29.6 percent at TexSan to 44.5 percent at Nix.