Program seeks to cut N.J. hospital readmissions

New Jersey seniors are readmitted to hospitals more often than those in most other states, often because of what experts say are preventable breakdowns in care. Such hospital readmissions nationally cost taxpayers billions.

In the next few days, Virtua Health plans to launch an ambitious effort to tackle this problem by better educating its departing patients and reconnecting them to family doctors.

The South Jersey system hopes to ease the often treacherous transition period when medication errors often occur and follow-up care can be missed.

The effort - one of 14 pilot projects launched by Medicare across the country - will focus on Medicare patients in 44 communities in Burlington, Camden, and Gloucester Counties.

The four-hospital Virtua system will seek to ensure that all discharged Medicare patients clearly know what medicines they should take.

It plans to arm patients with paper medical records that detail their health problems and summarize their care.

And hospital staffers will work to get discharged patients to visit their family doctors soon after discharge.

"The major goal is to reduce readmissions within 30 days" of a discharge, said Gregory H. Busch, medical director of Virtua's Berlin hospital and post-acute services.

Virtua's goal is reduce Medicare patient readmissions from the current 19 percent to 16 percent, he said.

That would put its rates in line with those of hospitals in states such as Oregon, Washington, and Utah that tout the nation's lowest 30-day rehospitalization rates, according to a recent study in the New England Journal of Medicine.

Other South Jersey providers will also join in the effort led by Health Quality Strategies Inc., the state's quality-improvement organization, which coordinates the project for the federal Centers for Medicare and Medicaid Services.

Hospital readmissions cost Medicare $17 billion, 17 percent of the $102 billion that the agency paid hospitals in 2004, according to the New England Journal study.

With nearly 22 percent of its Medicare beneficiaries back in hospital within a month, New Jersey was among the five states with the highest rehospitalization rates, the study found.

"We need to start paying for quality of care instead of paying for quantity of care," said co-author Mark V. Williams, chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago.

In 2007, at least 38,299 Medicare patients were readmitted to New Jersey hospitals, where they racked up $2.3 billion in bills, according to an Inquirer analysis of hospital billing records.

More than 100,000 patients of all ages were readmitted to Garden State hospitals in 2007, generating $4.6 billion in hospital charges. The cost of that care likely exceeded $1 billion.

Williams said that not every readmission was avoidable but that many resulted from poor communication between caregivers and patients at the time of discharge.

For example, many patients did not see a doctor after they were discharged, which likely allowed treatable conditions to deteriorate, Williams said.

Three of four Medicare beneficiary readmissions could be preventable, Charlene Frizzera, acting administrator of CMS, said in a statement.

"This situation can be changed by . . . approaching health care quality from a communitywide perspective," she said. Virtua, the largest provider in the targeted areas, said it was trying to take a wider view.

"As a health-care system, we are no longer just responsible for isolated episodes of care, but increasingly responsible for the entire continuum of care," said James P. Dwyer, Virtua's chief medical officer.

"When a patient leaves our hospital, it is no longer satisfactory to just have provided care. We have to make sure that the ongoing process of care continues and is effective."