Hospital-to-Home Patient Care Gets a BOOST


NATIONAL HARBOR, MD—Avoiding unnecessary hospital readmissions may be the most touted benefit of improving care for discharged patients, but better care can also limit patients’ potential to experience adverse effects after leaving the hospital.

“There’s a lot more to care transitions than readmissions,” said hospitalist Jeffrey Greenwald, MD, SFHM, faculty member of the inpatient clinician educator service at Massachusetts General Hospital in Boston during a session on lessons from SHM’s Project BOOST yesterday at HM13. “We’re trying to improve transitions to reduce adverse effects” from ineffective or unsuccessful hospital discharges and transitions of care, he said.

But, Dr. Greenwald acknowledged that the federal Hospital Readmissions Reduction Program and reimbursement penalties, which began last October, has increased attention on the quality of transitional care by U.S. hospitals and their hospitalists.

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About two-thirds of U.S. hospitals now experience automatic deductions of up to 1% of their Medicare reimbursement for high readmissions rates, based on experience with three diagnoses posted between 2008 and 2011. By fiscal year 2015, penalties will rise to 3% of hospitals’ Medicare reimbursement for a longer list of diagnoses, but those penalties will reflect the readmissions that hospitals experience today, said co-presenter Mark Williams, MD, FACP, MHM, chief of hospital medicine at Northwestern University in Chicago and a Project BOOST principal investigator.

SHM launched Project BOOST in 2007, and 160 hospitals have participated to date. Another national cohort is planned for this fall, with a July 31 application deadline. Preliminary results from pilot intervention units at 11 of the first 30 BOOST hospitals showed reductions in readmission rates from 14.7% to 12.7%, Dr. Williams reported.

A more recent BOOST collaborative with BlueCross BlueShield of Illinois and 27 hospitals in that state suggests a 25% decrease in readmissions on the BOOST intervention units. The “special sauce” in these achievements, Dr. Williams said, is the involvement of the expert BOOST mentors to help hold the site accountable.

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