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Jersey City, Hackensack tackling overuse of ERs to avoid Obamacare penalties

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A look at the new Hackensack University Medical Center at Pascack Valley.
A look at the new Hackensack University Medical Center at Pascack Valley.

As hospitals across the country work to cut down on readmission rates and save themselves from steep penalties imposed by the Affordable Care Act, Jersey City Medical Center is tackling the problem from its emergency room.

Like many other hospitals, it's struggling to support the "frequent fliers" who overuse its emergency services, said Dr. Susan Walsh, medical director of Jersey City Medical Center's accountable-care organization.

And when that same patient frequently returns to the ER, it causes a spike in the hospital's readmission rates, translating into hefty penalties to Medicare reimbursement under the ACA.

"Emergency rooms are not for managing chronic diseases," Walsh said. "We know, as health care workers, that it's not always the best choice for people."

So this past month, Jersey City Medical Center launched a program that will connect those frequent fliers with paramedics outside the confines of an emergency phone call. Those emergency responders will reach out to patients and offer to come by their homes, educate them about their illness and check their houses for safety issues.

Walsh said that program is one of several the hospital has put in place in response to the ACA and its penalty system. Recent data from Healthcare Quality Strategies Inc. shows that, for the period from April 2012 to March 2013, Jersey City Medical Center saw a 14.3 percent reduction in 30-day readmission rates, compared to the year before.

Jersey City isn't alone. Hospitals across the state are working to establish programs and policies that will cut readmissions and keep penalties at bay — efforts that go beyond the creation of accountable-care organizations.

At Hackensack University Medical Center, executives have been meeting regularly with long-term care facilities and home care agencies to ensure continuity of care, said Dr. Charles Riccobonno, vice president and chief quality and safety officer at Hackensack.

Riccobonno said that can be critical in reducing readmission rates. When the hospital first began working with long-term care centers, he would encounter situations in which, for example, a facility didn't know how to cook for someone who needs a low-salt diet — an issue that could send a patient with congestive heart failure right back to the hospital.

"There are so many things that go on outside the walls of the hospital … that will increase that patient's likelihood of coming back," Abbott said. "It's really a big collaborative effort."

So far, it's paying off. With the efforts currently underway at Hackensack, the hospital has seen a 5 percent decline in its overall readmission rates — not just those for Medicare patients, Abbott said.

"We expect … we'll see some more decreases in that," she said.

E-mail to: maryj@njbiz.com
On Twitter: @mjohns422

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