Better outcomes, lower costs

FARGO - Betty Hoppe, who must cope with congestive heart failure as well as emphysema, was a frequent visitor of the emergency room.

During a five-month period that ended in mid-March, she spent 21 days in the hospital because her chronic medical conditions were not well-controlled.

"It was like my home away from home for a while," Hoppe says. "I died in that hospital. A couple of times they brought me back to life."

But that's beginning to change for the 54-year-old Fargo woman.

On March 16, she enrolled in a pilot program at Essentia Health here that involves close monitoring by a nurse care coordinator.

That's Jennifer Henry, a registered nurse in Essentia's family medicine clinic, and one of two nurses involved in the patient care coordination pilot project.

"Betty was the first patient I signed up," she says.

The program targets patients with costly chronic diseases, the "sickest of the sick," for whom a simple office visit won't do.

Through better managing patients like Hoppe, medical teams can keep them out of the hospital, a welcome outcome for patients and their families in addition to the cost savings.

One national estimate shows avoidable hospital readmissions cost the government $12 billion a year. Under the new health reform law, hospitals will have a strong incentive to avoid readmissions deemed preventable.

Starting in October, Medicare will not pay for readmissions that it considers unnecessary.

The cost can be considerable. The bill for one of Hoppe's recent hospital stays, of three or four days' duration, was in the $20,000 range, she says.

On the other hand, if hospitals meet their cost-reduction targets, they will be able to share in the savings - handing them a fiscal carrot as well as a stick starting in 2014.

Essentia Health, which has 35,000 eligible Medicare beneficiaries throughout its system, and other hospitals will have to meet certain quality of care benchmarks as well as measures such as patient satisfaction.

"So it's connecting the quality of care into the whole payment system," says John Smylie, Essentia Health's chief operating officer. "Now there is incentive and potential reward."

He added: "Our target is to get at least a 2 percent savings."

Essentia recently became the first health system in the region to be accepted in a new government program to improve health outcomes for Medicare patients under its Shared Savings Program.

Since Hoppe enrolled in Essentia's care coordination program, she has been in frequent contact with Henry, usually by phone. Hoppe monitors her weight - water retention is an early warning sign of problems associated with heart failure - as well as her blood pressure.

Or, as Henry puts it, "Taking care of the little problem before it becomes a big problem."

As an example, Hoppe says of Henry's intervention, "She'll get me into the clinic right away instead of the ER, which is a lot cheaper."

Diligence on the part of the patient is critical to the program's success, Henry says. Most, but not all, of the patients she has worked with have been willing to do their part.

"The program only works for those who want to participate," she says. "People who don't want to change, I can't help them."

She credits Hoppe with doing her part, including regular participation in pulmonary rehabilitation, taking her medication and keeping her appointments.

"Betty's done all this work herself," Henry says. "It's not me doing that."

For her part, Hoppe says she's come to learn the importance of sticking with her twice-a-week therapy routine. She missed some sessions because of extreme heat and high humidity - difficult for those with breathing problems - and noticed a setback.

"My legs, I can hardly walk," Hoppe says before starting a recent therapy session. "It's terrible."

Henry, who first met Hoppe when she staffed the emergency room, sees improvement in many of her coordinated care patients.

"On a daily basis I have people thanking me and that's very rewarding for me," she says.

"You are super woman," Hoppe says. "I'm glad you're around."

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Readers can reach Forum reporter Patrick Springer at (701) 241-5522