|Minnesota Providers Fighting Readmission Trend
To reverse a trend of Medicare hospital readmissions
right after discharge a hospital, doctors and a health plan in Edina,
Minn., have marshaled their resources to tackle the problem head on at
Fairview Southdale Hospital. "Nationally, 20 percent of hospitalized
Medicare patients are readmitted within 30 days of discharge," said Dr.
William Nersesian, CMO of Edina-based Fairview Physician Associates
(FPA). "We recognize that some readmissions are unavoidable. However,
preventing avoidable readmissions keeps patients healthy and holds
FPA is a network of 1,200 independent, Fairview employed and University of Minnesota primary and specialty physicians.
Swift follow-up with patients is key to preventing
avoidable hospital readmissions, said Dr. Barry Baines, associate
medical director of UCare, an independent, nonprofit health plan
serving 200,000 members enrolled in Minnesota health care programs, as
well as Medicare in Minnesota and western Wisconsin.
Each prevented readmission will keep patients healthier and could save at least $5,000 per patient, Nersesian said.
"This pilot is designed using evidence-based data to
reduce variation and establish standardized processes," he added. "We
hope to see a 20 percent or more drop in preventable readmissions to
the hospital but we will welcome any progress, and will share our
learning with the system."
The participants have implemented specific strategies to cut down on readmissions. They are:
- UCare provides an incentive to FPA primary care
providers to see UCare for Seniors Medicare Advantage patients within
five business days of discharge from Fairview Southdale. UCare will
make sure that patients are correctly taking the right medications,
understand what is necessary for good health and what to do if problems
- FPA nurse case managers will follow up with
discharged UCare for Seniors patients in the hospital and by phone to
make sure they understand their medications and how to take care of
- Fairview Southdale social workers will work with FPA
nurse case managers and identify avoidable reasons that might return
patients to the hospital;
- Fairview Southdale hospitalist physicians will urge patients to see their clinic providers within five days of discharge; and
- Fairview Southdale pharmacists will thoroughly review with patients their current and new medications.
Addresses: Fairview Southdale Hospital, 6401 France Ave. S., Edina, MN 55435; (952) 924-5000, www.Fairview.org. UCare, 500 Stinson Blvd. NE, Minneapolis, MN 55413; (866) 457-7144, www.ucare.org. Fairview Physician Associates, 3400 W 66th St., Edina, MN 55435; (952) 914-1800, www.fpanetwork.org.