Spring 2013

No more revolving door

Can social workers reduce hospital readmissions?


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Mike Austin

A baby boomer turns 65 every 11 seconds. By the time you finish this paragraph, one will have blown out the birthday candles and applied for Medicare.

As a huge generation of Americans age, they’ll pack hospitals with a variety of gerontological ailments, from acute bronchial infections to broken hips. Big boon to a hospital’s bottom line? No.

Under the Affordable Care Act, Medicare won’t reimburse hospitals for the cost of treating an aging patient if that patient is readmitted within 30 days. The patient could be treated for pneumonia, go home and break a hip, but the rule remains. With hospitals spending between $10,000 and $31,000 (averaging about $18,000) for a typical stay, and readmissions hovering around 35 percent, that’s a big loss.

So Binghamton University researchers from the College of Community and Public Affairs (CCPA) and the SUNY Upstate Medical University have teamed with a local hospital to seek new, low-cost ways to keep seniors from needing readmission while improving their quality of life.

The two-year study, now in its final year, was designed to collect data from 100 or more patients at high risk for hospital readmission but able to live independently, says Laura Bronstein, interim dean of CCPA, professor and chair of the Department of Social Work, and director of the University’s Institute for Intergenerational Studies.

Her task was to create an interdisciplinary training program so social workers understand the medical factors that can complicate recovery and so medical providers understand the everyday living issues that can cause hospital readmission.

Making contact

Social-work students were assigned to follow up with patients released from United Health Services’ Wilson Medical Center in Johnson City, N.Y.

The monthlong follow-up begins with a phone call to make sure the patient is recuperating, says Kris Marks, LCSW, manager of clinical social work at UHS. A home visit follows, and the assessment starts outside: Are the sidewalk and driveway shoveled during a cold upstate New York winter? Are steps to the door difficult to navigate for someone who may have mobility problems? Is the garage door easily opened?

Inside, the examination continues. How does the patient feel? Are there any pain- or medication-related side effects? Is the patient making follow-up appointments? If not, why not? Does the patient have adequate support — friends and relatives who can help with everyday chores such as cooking or driving?

Gaps in the recovery process can lead to a complication that can require a hospital readmission.

“A big piece of making this work is making sure people follow up with their primary-care physician,” Bronstein says. “There are so many conditions that people have, it’s hard to tease out [what can lead to readmission].”

Sometimes all that’s needed is a tweak of available services, Marks says, such as arranging for Meals on Wheels or a short-term home-health aide. “I think some people just benefit from the contact they get,” she says.

The model works

Data collection will continue into the spring, says Dr. Shawn Berkowitz, medical director of the study, director of geriatrics at UHS and a clinical assistant professor at SUNY Upstate Medical University. Analysis will follow and publication in academic journals, with luck, will come by the end of the year. Preliminary analysis of the first 96 participants is promising.

UHS has a readmission rate of 18 percent, he says, about half the national average, and reflected in the control group. But only 7 percent of program participants have been readmitted to the hospital, compared with 15 percent of the control group.

If other hospitals can duplicate that, they would save hundreds of thousands, even millions of dollars a year. Berkowitz calculates that a social worker could create savings equal to his own salary and benefits by preventing just seven readmissions a year.

And it’s a different approach than other studies have suggested, Berkowitz says. Health providers tend to adopt an education model — teach patients to care for themselves and they will. But this is a social empowerment model. “Social workers are trained to empower people,” he says. “They encourage people to take
ownership of their own care.”

But Berkowitz would like to see another 1,300 participants in similar studies at other hospitals.

Also, Marks notes that participants were selected for a variety of reasons, including the ease with which a social worker could visit. Most participants were from the 125,000-resident urban core of Binghamton, N.Y., the rest from outlying areas. More urban hospitals could see greater savings, but rural hospitals may suffer because of
increased travel times and distances.

Larger, urban hospitals serving poorer patients are a good target, according to several studies published in January’s Journal of the American Medical Association. They, and large teaching hospitals, are the most likely to lose Medicare reimbursements, as are hospitals with poor coordination of post-release care — exactly the sort
of thing the Binghamton study is examining.

“It starts here at the hospital,” Marks says. “There’s a very strong sense of empowerment.”

The power needs to come soon. In the time you spent reading this story, 20 more people became eligible for Medicare.