More on Reimbursement

Providing follow-up care after heart attack helps reduce readmissions, reimbursement penalties

Nurse navigators in particular can be important tools for both patients seeking better care and providers seeking more consistent reimbursement.

Jeff Lagasse, Associate Editor

A program designed to help heart attack patients with the transition from hospital to outpatient care can reduce readmissions and deaths and increase the number of patients keeping follow-up appointments, a new study suggests.

Findings from the Sanger Heart and Vascular Heart Care Navigation Team study indicates the program is effective enough to make a statistically significant dent in readmissions, which in turn helps providers avoid reimbursement penalties, which the Centers for Medicare and Medicaid Services imposes based on readmissions and other metrics.

And since care quality generally improves, with fewer deaths reported, it has the potential to increase patient satisfaction, an important consideration in an increasingly consumer-driven industry.


The Heart Care Navigation Team was established in 2017 with the goal of reducing unnecessary readmissions, improving mortality and improving patients' experience. Patients in the program are assigned a health advocate and a nurse navigator who meet the patients while they're in the hospital.

The team helps with timely access to follow-up care, promotes self-management and addresses patients' questions or concerns for a period of 90 days after discharge.

In contrast to the previous model -- which saw providers tell patients to call the office where they often spoke to people they didn't know -- the nurse navigator is a person familiar to the patient. The navigator calls the patient within 24 to 48 hours of discharge, and then every two to four weeks for three months.

Among the nurse navigator's responsibilities are ensuring patients are going to their doctors' appointments, that they have their medicines and being available for questions about their treatment.

Before the program was implemented, the discharging nurse would provide discharge education and cardiac rehab would provide information. That was it.


Researchers compared data from 560 patients treated for a heart attack between July 2016 and June 2017, before the program began, to 421 patients treated in the year after the program was implemented, from July 2017 to June 2018.

The 30-day readmission rate before the program started was 6.3 percent and fell to 3.7 percent the year after the program began. There was a reduction in the 30-day death rate (5.75 percent before versus 4.57 percent after program implementation) and an increase in patients' follow-up appointments made prior to discharge (78 percent compared ti 96 percent).

The study also found an increase in guideline-based care from 83.3 percent to 85.1 percent, as well as an increase in cardiac rehab referrals (85.7 percent versus 88.6 percent).


Scoring models used to predict 30-day readmission risk in the general hospital population may not accurately predict readmissions for patients in the neurocritical care unit, December research shows.

Neurology is just one of many clinical areas affected by reimbursements tied to readmissions. Cardiology patients have better survival rates at hospitals atop the U.S. News and World Report rankings, but the risk of readmission is more or less the same -- and with 30-day readmissions tied to reimbursement, that could pose an issue for providers at all points on the spectrum.

Twitter: @JELagasse

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