Rutgers Study Ranks N.J. Hospitals that Prevent Avoidable Admissions
by Cliff, a 49-year-old Trenton resident with diabetes, kidney failure and a host of other illnesses, needed dialysis several times a week. But unable to sit through the tedious multihour treatments, he often skipped out early.
That bad habit backfired in 2010, when he was hospitalized 66 times at St. Francis Medical Center in Trenton and spent a month in intensive care at Robert Wood Johnson Hospital in Hamilton. The cost of his care during that period easily exceeded $1 million, according to physicians familiar with his case.
Patients like Cliff are why Trenton ranked the third-worst out of New Jersey’s 13 urban centers in a new Rutgers University study that measured how well medical and public health professionals kept the state’s poorest citizens healthy and out of the hospital from 2008 to 2010.
In the new era of health care since the passage of the federal Affordable Care Act in 2010, hospitals in urban areas face a new challenge: making sure poor residents don’t wind up in costly hospital beds or emergency rooms for things that could be headed off simply by taking their medication and making sure they keep appointments with their doctors.
The study examined how often patients used the emergency room for non-emergency reasons, were admitted to the hospital unnecessarily, or returned to the hospital within 30 days. It also focused on excessive emergency room users – those who used the ER at least six times.
“We are measuring the hospitals, which are really a mirror of what is going on in the community. When these rates are really high, the community providers are not doing an adequate job of keeping people out of the hospital and healthy,” said Joel Cantor, director of the Rutgers Center for State Health Policy, which authored the report. The Nicholson Foundation, a charity that encourages improvement of government health and human services programs, paid for the study.
“The intent of the study is to provide data to communities to think about how to make care better,” Cantor said. “A lot of things are aligning now to give hospitals and other health care providers the incentive to do better.”
The Affordable Care Act will reward networks of hospitals, doctors and other health care providers that keep hospital admissions low, when possible, by restructuring how they get paid and allowing them to keep some of the money they save by focusing on preventive care.
The state this year will fund the creation of five accountable care organizations – a network of hospitals, doctors and medical professionals that serve concentrated areas in which at least 5,000 Medicaid patients live.
The federal law also punishes hospitals that don’t perform. In October, the federal government began withholding as much 1 percent on all reimbursements to 62 New Jersey hospitals, out of 71, where Medicare patients were treated for congestive heart failure, pneumonia and heart attacks and were readmitted to the hospital within 30 days.
Overspending
The Rutgers study found the New Brunswick-Franklin Township region scored the highest among the 13 urban centers. Atlantic City-Pleasantville ranked lowest. But the report said every region unnecessarily spent millions during the 2008-10 study period, including $284 million that could have been saved in 2010 alone.
Teresa De Peralta, a nurse practitioner at Robert Wood Johnson University Hospital in New Brunswick, said community health services are getting stronger. With the support of a $4 million grant from the Robert Wood Johnson Foundation last year, de Peralta oversees the hospital’s Transitional Care Program with a corps of visiting nurses. The team meets with patients before they leave the hospital, then follows them for eight weeks after discharge.
Last month, a house call by a nurse found a 79-year-old heart patient having difficulty breathing, de Peralta said. Not only had he not picked up his medication from the pharmacy, but he also didn’t have the money to pay for it. Over the next two days, the team assigned him a social worker, arranged for prescriptions to be delivered, and scheduled a ride to the doctor’s office with the county senior citizens transportation service.
“Sometimes patients go home and they are still very vulnerable,” said de Peralta. “If you are only going to react, it will be too late – that’s why you must be proactive.”
During the 2008-10 period that Rutgers studied, public health services like vaccination clinics and prenatal services in Trenton were scarce because the city didn’t have the money to provide them, said Jim Brownlee, the city’s health officer. “People had no place to go. They ended up in the ER and on charity care.”
Transforming Trenton
Then the city’s clinics, hospitals and medical professionals, who traditionally competed against each other, came together in 2010 to form the Trenton Health Team. Now unnecessary emergency room visits are down 45 percent and avoidable hospital stays have declined 56 percent, said Ruth Perry, the team’s executive director.
“We can’t quantify how much money we’ve saved, but we know we have,” said Robert Remstein, vice president at Capital Health and president of Trenton Health Team. “More importantly, we’ve improved the provision of care for the people of Trenton.”
And Trenton officials say the case of Cliff, the man hospitalized 66 times, provided an opportunity for them to tackle the problem.
A nurse at St. Francis, a member of the Trenton Health Team, asked Cliff what he’d like to do to take his mind off the tedious kidney treatment. He liked to draw, he replied.
“She gave him poster boards and pens, and he drew for six hours,” said Christy Stephenson, executive vice president for Catholic Health East, St. Francis’ parent company. Since that breakthrough in November 2010, Cliff has been hospitalized only once, and he never misses dialysis.
“He’s on a (kidney) transplant list. He stopped smoking,” Stephenson said, who declined to reveal his full name to protect his privacy. “It changed his life.”
About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. Support for the Trenton Health Team was provided in part by a grant from The Nicholson Foundation. For more information, visit www.trentonhealthteam.org.
