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How Affordable Care Act Is Changing Chronic Care at Hospitals

‘Bridge coordinator’ program cuts readmissions by 35%

The Patient Protection and Affordable Care Act (PPACA) is accelerating changes in how hospitals treat patients with chronic conditions, such as diabetes, heart failure, and obesity, according to an article in the Philadelphia Inquirer.

Successfully treating those patients, who use many more health care services, have higher rates of hospitalization and more frequent emergency department visits, is challenging because many of their conditions are aggravated by unhealthy eating habits and inactivity. Chronic disease rates increase steadily as patients age, making this issue particularly important to the Medicare program.

Medicare has been paying a set amount for each hospital admission, regardless of the length of stay or the outcome. If patients were readmitted, even because they were sent home too soon, Medicare would pay again.

Now, as part of the PPACA, new payment and delivery models and mandates are being implemented to reward or penalize hospitals for their rates of 30-day readmissions, infection control, and patient satisfaction levels.

Like many hospitals, Temple University Health System in Philadelphia is adjusting to mandates to improve patient health.

Steve Carson, who leads Temple’s Center for Population Health, said its patients face challenges such as transportation and childcare needs, access to healthy foods, and safe housing, as well as lifestyle factors that include tobacco and substance abuse. Carson said Temple works with physicians and grassroots organizations that support patients.

Temple is participating in a federal initiative with the Einstein Health System and the Philadelphia Corporation for Aging on a care model called a “bridge coordinator.” In that program, a social worker connects with patients in the hospital at risk of readmission, follows them post discharge, and continues to check on them at home by phone. Carson said readmission rates for “bridge coordinator” patients dropped by 35%.

While individual hospitals may see improvements in care and cost reductions, health care economist Uwe Reinhardt said it’s too soon to tell whether the U.S. health system saves money.

Reinhardt, a professor of economics and public affairs at Princeton University, said the PPACA may improve the quality of the health care experience for the patient, but the cost savings have not yet materialized.

“The process doesn't work this quickly,” he said. “We will probably need 10 years to determine its effectiveness. The problem with Americans is we are extremely impatient people, and we don't like to hear that some things take a lot longer to know.”

Chronic diseases, broadly defined as long-lasting conditions that can be controlled but not cured, are the leading cause of death in the U.S. More than one-quarter (26%) of all Americans and one in 15 children have multiple chronic conditions. Moreover, 75% of seniors (65 years of age and older) have multiple chronic conditions.

People with multiple chronic conditions have increased mortality risks and account for a disproportionately high percentage of U.S. health care spending. In 2010, seven of the top 10 causes of death were due to chronic diseases. Two of these –– heart disease and cancer –– accounted for nearly 48% of all U.S. deaths. The total cost of heart disease and stroke in 2010 was estimated to be $315.4 billion. Cancer care cost $157 billion in 2010, and diabetes care cost $245 billion in 2012.

Source: Philadelphia Inquirer; July 5, 2015.


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