"It was a pretty big exposé when it came out," Lynch says. "Front page."
Internally, Lynch says, the hospital didn't think Medicare's label of "worse than" was fair, because Barnes-Jewish is an academic medical center and a major safety-net hospital serving a low-income, difficult population. "We believe that most of the readmission risk is beyond our control. But we believe some of it is within our control, and that there is opportunity for improvement, and we've had a focused effort on trying to improve that over the past three or four years."
So the hospital worked with the reporter over a series of interviews to explain what goes on behind the scenes of the discharge process, and the problems inherent in keeping patients from coming back not just in 30 days, but 60 days or more. They allowed the reporter to follow a nurse manager into a discharged patient's home.
Practically speaking, Lynch advises, "it's actually quite difficult to try to explain away the data. We know that because of the complexity of these types of calculations, error bars, and the limitations of claims data. You could potentially come across sounding very defensive."
Barnes-Jewish took a different approach, conveying that it took the scoring seriously, and acknowledged it could do better. Since it had known for more than a year the readmissions were high, it had launched several programs to get them down, and it itemized each one.
Those programs include a pilot program that provides a 30-day supply of low-cost medications to discharged high-risk patients, referrals to low-cost medication suppliers, and a postdischarge clinic specifically for low-income patients that ensures they see a primary care physician within the first seven days.
"We turned this into, ‘We are concerned about our patients' outcomes, and we are in a mode of continuous improvement,' " Lynch says.