More than 1 million home care patients are admitted to US hospitals annually, and many of these hospitalizations are preventable. In fact, reducing the hospitalization rate by only 3 percent would result in a Medicare savings of $2.7 billion.

As medical director of TMF Health Quality Institute, I’m working with the Centers for Medicare & Medicaid Services to reduce the acute care hospitalization rate in the home health setting. In more than three years, this rate has remained stagnant at 28 percent.

At times, a home health patient is so ill that hospitalization is the only answer, and sometimes, regardless of our actions, a patient’s condition continues to worsen and the only option is to admit him to the hospital. Physicians play an important role in making sure each patient receives the appropriate care. Sometimes, however, hospitalization is not the solution, and many times, it can be avoided.

As a physician, it’s always been difficult for me to deny acutely ill people admission to the hospital, but working on this CMS initiative makes me recognize that sometimes it’s best for the patient not to be admitted to the hospital. Physicians can take several actions while still providing high-quality medical care to reduce the need for hospitalizations and improve the quality of a patient’s life.

For example, by establishing and maintaining effective communication with home health agencies in your area and in your local hospital emergency rooms, you will prevent many home health patients from ending up in the hospital. Many conditions, such as dyspnea, can be detected and treated early. When home health providers observe a patient’s health starting to deteriorate, they need to feel comfortable to call your office immediately because early treatment by the patient’s trusted physician can make a difference. Take time to evaluate and refine your communication processes when a patient’s health declines in the homehealth setting. Discuss the processes and areas for improvement with home health providers.

Communication also is critical when a home health agency sends a patient to an emergency room, but the patient is not sick enough to require hospital admission. It is essential for the ER physicians to know whether the patient is receiving home health services. That way, the patient’s primary care physician can be notified for timely follow-up, and the home health service can be intensified as indicated. These steps can improve the probability of successful outpatient treatment, and reassure the patient and family that the patient will remain under the care of his physician.

My goal in writing this column is to ask for your help and leadership in reducing avoidable hospitalization and in helping improve the quality of life for our patients. More than 400 Texas home health agencies are taking steps to improve the hospitalization rate, but they can’t do it without your support.

TMF provides these agencies with quality improvement training, teleconferences and workshops, evidence-based quality improvement tools and resources, and monthly data graphs updating the agency on its progress for acute care hospitalization. However, that’s not enough. I strongly believe that without your help, commitment, and leadership, we will not improve this rate.

CMS would like to save money, and the agency would like to do this through the provision of the most timely and appropriate care for each patient. This can be done without lowering standards, and it might improve care in some
situations.

Physicians are engaged in efforts to convince Congress that we need to be paid fairly for our work with Medicare patients. To further these efforts, it could not hurt to be able to show a reduction in acute care hospitalizations and to point to the role of physicians in that success.

As physicians, taxpayers, children, and grandchildren of Medicare beneficiaries and future Medicare beneficiaries, we must do what we can to preserve this program. This is but one part of a larger effort, but it is an important part.