'What health care reform is all about’

Each year, about one in five older patients discharged from the hospital is rehospitalized -- usually within two weeks -- at enormous cost to the health care system and the patient's well-being.

But when 79-year-old Andy Undem was discharged from Fairview Southdale Hospital after three weeks with pneumonia and a lung infection, he went directly into an experimental program that is pointing the way to billions of dollars in savings for Medicare.

A year-long study at a Minneapolis nursing home showed that focused care by a team of University of Minnesota medical specialists cut the number of older short-term patients who were rehospitalized by 20 percent -- to a rate 33 percent below the national average.

The savings could be huge. High rates of rehospitalization cost the federal Medicare program more than $17 billion, a recent study estimated.

"I can't tell you about savings," said Undem, a retired president of the old First Produce State Bank in downtown Minneapolis, now site of the Target Center. "I just know their job was to get me better so I could go home, and that's exactly what they did."

The program in the Transitional Care Unit at Walker Methodist Care Center is the only one of its kind, officials say. Findings of the state-supported study indicate that if the program were in place at other short-stay centers that help patients transition from hospital to home, the annual savings could top $5 billion.

They are working now to pin down more precise savings and figure out how other short-term care units can adopt the model they have developed.

In the program, a physician, nurse practitioner, pharmacist and sometimes a dentist from the University of Minnesota join forces to care for patients, with special focus on the 75 percent most at risk of returning to the hospital. The idea is to avoid drug interactions, care lapses and other serious but preventable complications that are most likely to send the patient back to the hospital.

"This is really what health care reform is all about," said Walker Methodist administrator Mark Kinne. "We're giving people the right treatment so they get healthier and go home faster, and do it in a way that actually costs less money."

Who is most at risk?

The program began in 2002, when the seven-member university team came to Walker's 44-bed Transitional Care Unit after working together at Wilder Senior Clinic in St. Paul, which closed.

Dr. Thomas Lackner, a team member who also teaches pharmacy students at the university, developed a system to identify patients most at risk of returning to the hospital, and the specific tests and care most likely to keep them out.

"The biggest risk factor is medications -- new medications you get in the hospital, or changes in medications when you leave, or pain medications," Lackner said. Other risk factors can be heart disease, diabetes, constipation or diarrhea, which can lead to dehydration that causes weakness, confusion and falls.

The team also helps train about 100 students a year at the transitional care unit.

New way to treat delirium

"We know this works, and we're demonstrating it," said Dr. Teresa McCarthy, director of the unit and also assistant professor at the university. "The university and Walker are essentially paying several hundred thousand dollars that the extra care costs. In the long run, we need to convince Medicare and the health plans that they can save a lot more by investing in this kind of care."

To help finance the study, the state Department of Human Services, which pays for most of the nursing home care, raised Walker's reimbursement rates by $430,000 for one year. Now it is seeking a similar grant to study the impact of the program on a new 20-bed section of the transitional care unit that treats older people with delirium.

"These are the people who are at great risk. If they go back to the hospital with delirium -- which is curable -- half will die," McCarthy said.

"When we get them, some patients are yelling, screaming, crying, lost. Often they're on antipsychotic medications, given in the hospital to quiet them," she said. "But the drugs, or drug interactions, often are the problem, so we wean them off the drugs as soon as possible so we can figure out what's wrong.''

An earlier study, to be published soon, showed that the team approach reduced the number of days in transitional care by an average of one week, to about 17 days, for an average savings of about $3,000 per patient.

"We knew it was the right way to practice medicine, and we knew we could keep improving it," said McCarthy.

Warren Wolfe • 612-673-7253