Any one providing care in the hospital setting has seen it before – patients readmitted for issues that should have been addressed by their primary physician.
In too many cases, patients with highly treatable issues end up back in the emergency room because they didn’t follow up with their physician or didn’t follow their care plan post-discharge.
In many cases, patients with chronic conditions are the ones most likely to fall through the cracks, adding to costs of hospital care. A 2010 analysis for the Center for Healthcare Quality & Payment Reform found that for patients with the six most common chronic conditions -- heart failure, COPD, AMI, depression, asthma and diabetes -- hospital admission rates averaged 14 percent of all medical admissions.[1] Following discharge, 22 percent of these patients were readmitted within 30 days, and 47 percent were readmitted within a year. A patient with heart disease, for example, could spend an average 5.3 days in the hospital with costs of $18,266.
Importantly, the analysis also found that among patients with chronic diseases who are readmitted to the hospital, fewer than half of the readmissions occur within the first 30 days of discharge -- rather, almost half of these patients and over half of patients with COPD and heart failure are readmitted to the hospital within 12 months.
These figures are even more disturbing when one considers that as the population of the United States ages, the number of people with chronic diseases will grow. According to the Centers for Disease Control & Prevention (CDC), three in four Americans over the age of 65 have two or more chronic health conditions. In the United States, the number of Americans ages 65 and older is projected to increase from 15 percent of the population in 2015 (46 million) to 24 percent (98 million) by 2060.[2]
Clearly, the healthcare system has a looming problem with these demographic shifts. For those in the health system, better solutions are needed to ensure patients who leave the hospital are unlikely to return for conditions that could have been prevented.
To promote better patient health and avert needless readmissions, in January 2015, the Centers for Medicare and Medicaid Services (CMS) began to reimburse for the Chronic Care Management (CCM) services as a means of further supporting patients in between physician visits. CCM services are non-face-to-face services provided to Medicare beneficiaries who have multiple chronic conditions.
Chronic care management services can help patients manage conditions such as arthritis, asthma, cancer, diabetes, hypertension, heart disease, and osteoporosis. A typical service may help a patient track her medication use, schedule follow-up physician visits after a hospital stay, and follow the care plan provided when he or she was discharged. Primary care physicians who offer these services can rest easier knowing a trained professional is following up with patients and reporting back issues through electronic health records.
CCM services that are reimbursed under these new rules include electronic and phone consultations with trained professionals. Under this arrangement, patients benefit from timely and specific consultations with trained professionals as part of chronic care management services.
While early participation in the program by PCPs has been slow, CMS estimates 70 percent of Medicare beneficiaries—roughly 35 million people—have two or more chronic conditions and would be eligible for the care services.
We can perhaps attribute the slow adoption of CCM services to a lack of knowledge about them. According to a recent survey by Quest Diagnostics, four in five PCPs (82%) say their patients with chronic conditions would benefit from using a service like CCM. However, they don’t all realize that Medicare will pay for it, but once they find out, nine in ten (90%) say they would likely use this service for their patients.
Patients are receptive as well. Almost half of patients (45%) said they would likely use a service in which their doctor or nurse care coordinator would call and talk with them about their conditions, make sure they are taking their prescriptions and answer questions they may have.
Currently, preventable hospital readmissions are estimated to account for more than $17 billion in Medicare expenditures annually, according to CMS. We know care management services work-- if we communicate more broadly to doctors and patients that these services are available and being funded through Medicare, I’m confident we can reduce it further.
Dr. Jeffrey Dlott, MD is a medical director at Quest Diagnostics. Quest Diagnostics is the world’s leading provider of diagnostic information services. In 2018, the company launched Chronic Care Management (CCM) services nationwide to help providers close gaps in care for patients with multiple chronic conditions.
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1Pittsburg Regional Health Initiative Readmission Briefs. Brief 1: Overview of Six Target Chronic Diseases. June 2010. http://www.chqpr.org/downloads/PRHI_ReadmissionBrief_ChronicDisease_June2010.pdf. Accessed May 2018.
2Population Bulletin. Vol 70, No. 2: Aging in the United States. December 2015. https://www.prb.org/wp-content/uploads/2016/01/aging-us-population-bulletin-1.pdf Accessed May 2018.