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���ϲ����� Note: The article below describing Boston’s Beth Israel hospital and its experiences in trying to reduce admissions highlights several of the issues NY hospital and provider networks will face moving into the DSRIP program. The federally incentivized reinvestment will force hospitals to reduce avoidable hospitalizations by 25%; while that is ultimately a goal that contributes to and results from better health care, it is also difficult to force hospitals—many of them struggling—to give up 25% of their profits. And yet, through DSRIP or other federal mandates, hospitals that do not control admissions have their costs restricted or are fined. As noted below, hospitals recognize that reducing admissions internally does not fix this financial catch-22. Expanding services, partnering with provider networks, and engaging consumers through outreach and care management are ways to expand practice and income while improving quality and efficiency. Those goals, inherent to DSRIP, must be recognized by hospitals initially in order for all stakeholders to benefit from their efforts.

Learn more about DSRIP through an expert panel at this year’s Executive Seminar! The discussion will be timely as proposals will be due to the state this summer. The last day to register with reduced rates for the Seminar is today. Register !

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Top Boston Hospital Begins to Tackle Readmissions Problem

Kaiser Health News; Rachel Gotbaum, 4/3/2014

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Beth Israel Deaconess Medical Center is a highly regarded teaching hospital in Boston, but in 2012, the hospital found out it had one of the highest rates of readmissions among Medicare patients in the country. That meant of more than $1 million—and a lot of soul searching for the staff, says Dr. , the head of quality for the hospital.

“Patients coming to our hospital, getting what we believed was high quality care, were coming back at an alarmingly high rate,” says Yang.

The hospital was providing quality care to patients when they were in the hospital, but it turned out that focus was too narrow, says Yang.

“In the hospital we provide a lot of structure, we provide a lot of staff. We provide a lot of expertise to manage every moment of their illness,” he says, “but as soon as they leave, the complexity of their situation probably explodes.”

Lila Gross, 84, is one of those complex patients, suffering from heart, lung and kidney problems. Gross frequently ended up in the hospital, and her daughter Geri Segel says the family always left with unanswered questions.

“She would check out of the hospital and there was no one who followed through,” says Segel. “We had a hundred questions and we had to wait for the next catastrophe to get her back in the hospital��to find more answers.”

Now Lila Gross is one of 2,000 Medicare patients who��is treated in Beth Israel Deaconess’ . The idea behind the program, which stands for Post-Acute Care Transitions, is to keep Medicare patients from bouncing in and out of the hospital. Studies show that about 30 percent of elderly patients return to the hospital within 30 days of being discharged.

With a $5 million federal grant, PACT nurses and pharmacists now track Medicare patients who are at high risk for readmission. Nurses call patients and their caregivers, communicate with a patient’s primary care provider and arrange for rehabilitation or visiting nurses. Pharmacists are also on hand to answer medication questions.

Siegel says having PACT nurse Susan Sorlien as an advocate for her mother means the family now knows when they should bring their mother into the hospital and when it can be avoided.

“Susan would keep touching base with my sister and myself to make sure that mom was taking everything and that we understood how to use everything and that mom was doing well,” says Segel. “When we had questions, Susan had an answer.”

So far Beth Israel Deaconess has reduced its readmission rate by 25 percent and its fines have also been reduced. According to Yang, who directs the PACT program, the hospital is now providing better care for its older patients.��But there’s a catch, he says, because the hospital loses money for every bed it keeps empty.

“For a patient to come into the hospital, whether it’s a readmission or not, we collect revenue and yet we are being penalized for this,” he says.

The attempt to control costs under Obamacare focuses on hospitals because hospitals are expensive, says Ashish Jha, a professor at the Harvard School of Public Health. But the new readmissions policy alone is probably not enough to bring down those high hospital costs, he says.

“The problems with policies like these is that they are piecemeal, they are fragmented and they are little band aids,” says Jha. “I think we need a much more comprehensive approach to how we pay for healthcare.”

This story is part of a collaboration between Kaiser Health News and the WBUR-NPR show . Read the full story

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