Transitional care interventions can prevent readmissions for congestive heart failure patients and save healthcare costs overall by keeping people healthier. But they're money losers for individual hospitals under current Medicare payment structures, according to a randomized trial at Baylor Medical Center Garland.
"We're raising a red flag," said Brett Stauffer, MD, a Baylor internist with the system's Institute for Health Care Research and Improvement who, with colleagues at Yale University Medical School, authored the report.
"While we do believe that if you were to look at the big picture, these sort of interventions do probably save (Medicare and other payers overall) money, from the hospital provider's perspective – and we have to be sensitive to this – the hospital can end up losing a considerable amount of money if they're successful at preventing readmissions."
That's because Medicare does not pay the average $1,100 cost of providing the intervention to each CHF patient.
Stauffer's report was published Monday in the Archives of Internal Medicine.
Stauffer and colleagues set out to test a model intervention at a medium community hospital, such as Baylor's 268-bed facility in Garland, to see if intervention strategies would work outside a larger academic hospital setting. An advanced practice nurse led a team that instituted goal-setting, reviewed health behaviors and skills of the patients, made at least eight home visits, and was available by phone 7 days a week.