Washington’s health care law has prompted some hospitals to change how they care for patients who are at the greatest risk of being readmitted. One program at the Seton Healthcare Family aims to spend a little to save a lot.
Carla Herber has worked in hospitals since she was a teenager. In her senior year of high school, she completed her EMT training.
“I’m very much a people person and want to nurture and want to care for people, so this is my opportunity to that,” said Herber, who is now a patient advocate in a new pilot program at Seton: A small team of medical and mental health workers focused on low-income patients who are a high risk of being readmitted to the hospital. The industry term for it is an “extensivist” model.
Part of Herber’s job is paying visits to some of her patients, such as Ari Rose, 32, who lives in an affordable housing community in South Austin, right next to I-35.
Rose is from California. Last March, he went on a harrowing journey that began with a visit to the hospital.
“I went in for pneumonia,” Rose said. “I thought it was due to quitting smoking, and I was really just drowning in my own fluid, so they instantly admitted me.”
Rose was recently diagnosed with HIV. After about 10 days in the hospital he was starting to feel better, but then things went downhill.
“My lungs collapsed,” he said. “I was put on a respirator, and I was put on a machine called ECMO, which oxygenated my blood -- took all the blood out of my system, oxygenated it and put it back in.”
By the time he was released, Rose weighed 90 pounds and was in a wheelchair. He didn’t have a lot of money, and his bills were being paid by the Medical Access Program. MAP is run by Travis County’s Central Health hospital district, and it provides health coverage to low-income people who aren’t eligible for Medicare or Medicaid.
But MAP wouldn’t pay for Rose’s HIV medication. That’s where Herber stepped in.
“They were not going to discharge him from the hospital, obviously, without his HIV meds, so that was a whole-day process of getting all this medication, coordinating all his equipment to get his wheelchair and oxygen ready, because he needed all these things to leave the hospital,” Herber said.
The extensivist team followed up with counseling, weekly check-ins, helping him get to his doctor’s appointments. They gave him some taxi vouchers.
“Helped me get back on my feet and do it myself, which is amazing,” Rose said.
This program is called Seton Total Health Partners. And they’re not doing it just to be nice. The extensivist model is one of several ways that hospitals are responding to a new regulatory environment brought about in part by the Affordable Care Act, aka Obamacare.
“What we constantly talk about it is, the goal is to spend $2 million to save $20 million,” said Mark Hernandez, an administrator at Seton. He says they save money by getting patients to their doctor’s appointments and getting them their medication so they don’t wind up being readmitted or just showing up at the ER.
“Emergency department care is expensive,” Hernandez said. “That’s a large cost in itself, even if they don’t get admitted to the hospital. There’s quite a bit of money that gets charged and never collected around emergency department care. It’s an expensive way to provide care.”
The federal Centers for Medicare and Medicaid Services began charging hospitals last fall for patients who were readmitted within 30 days of being discharged. And the government is also penalizing and rewarding hospitals based on patient satisfaction.
Eric Thomas, a professor at the University of Texas Medical School at Houston, says people who work in health care have always wanted to do this kind of thing. But the financial model hasn’t been there to support it. And although that’s changing, hospital administrators still face a careful financial calculation.
“For the hospitals, it’s hard to know for sure if they win financially or not,” Thomas said. “They want their beds filled. The more patients that they have coming, the fuller the hospital, the more money they make. So now they’re trying to get in the business of keeping people out of the hospital, but there’s a bit of a financial balancing act there.”
At this point, Seton’s pilot project only works with a small number of low-income patients. Some people who have health insurance but could still use the help wouldn’t qualify. But for now, people like Ari Rose can access some support. And people like Carla Herber can have more access to patients and more resources to keep them out of the hospital.