Providers to docs: We can help you

Monday, May 24, 2010

FULLERTON, Calif. - Hospital readmission rates for certain disease states cost Medicare up to $20 billion annually, and a provision in the recently passed healthcare reform bill aims to reduce those numbers. Industry consultant Patrick Dunne, president of Fullerton, Calif.-based Healthcare Productions, spoke with HME News recently about how respiratory providers have an opportunity to market themselves as value-added partners that will help hospitals reduce those rates.

HME News: What's the new provision about?

Patrick Dunne: Hospitals are now required to track and report their 30-day readmission rates for patients with congestive heart failure and pneumonia, but it's just a matter of time before COPD is included. Medicare is moving forward with what they call "value-based purchasing," which is short for "pay for performance." Hospitals that have very high readmission rates aren't going to receive as much reimbursement as hospitals that don't.

hme: How should an HME provider market itself to hospitals seeking to reduce their readmission rates?

Dunne: Go in and strike up a conversation with the head of the respiratory department and say, "We realize that your hospital is probably going to be looking to reduce the readmission rate for COPD and we think we can help you do that. We'll work with you to make sure the oxygen prescription is optimized and we'll come in and help you do the patient education."

hme: Are HMEs uniquely suited to fill this role?

Dunne: Absolutely. They are the ones that actually see the patient's condition when they are first discharged. They can see if the patient is very fragile and going to need a lot of assistance or if the patient knows what they are doing. They are able to prioritize patients at risk for what I call failure to recover at home. In other words, if they do not fully recover at home, they bounce back to the hospital.

hme:  Why are the readmission rates for these patients so high?

Dunne: These patients are not being properly prepared when they are discharged to assume these responsibilities. The discharge process is usually very quick: "Let's get the patient out as fast as we can and it's no longer our problem."