The back room of Gerdes and Sons, a Brainerd-area business where deer are skinned and quartered, was an odd location for community paramedic David Smith to examine his patient, Justin Gerdes.
But it didn’t change Smith’s goal: keeping Gerdes out of the hospital. Both his patient’s health and the bottom line of his employer, Essentia Health, were at stake.
Gerdes had been admitted this fall to St. Joseph’s Medical Center in Brainerd for a fungal infection that got into his blood stream and damaged his heart. The 42-year-old was at risk for going back to the hospital if he overexerted himself. On the other hand, it was the busy season for his all-purpose maintenance business. There were docks to pull, yards to maintain, pumpkins to sell and wild game to dress.
“I understand. I live in reality,” Smith told Gerdes on Oct. 15 after checking his blood pressure. “Just as long as you’re not getting lightheaded, dizzy. Those are the cardiac symptoms you really need to look out for.”
Paramedic visits and other efforts have helped Minnesota hospitals reduce readmissions for patients such as Gerdes and avoid steep federal penalties from Medicare, the massive federal health care program for senior citizens. New federal data shows that 16 Minnesota hospitals avoided any penalties at all out of 46 scrutinized for readmissions.
The other 30 hospitals will collectively pay $2 million to $3 million in federal penalties next year, which is relatively small compared to the billions of dollars that Medicare reimburses them for medical care. But the penalties aren’t just about money. They can be publicly embarrassing, and an indication that hospitals are struggling with value-based care, an industry term that means taking better care of patients for less money.
“Everybody loses if patients get readmitted that shouldn’t have needed readmissions,” said Dr. Cathy Cantor,chief population health officer for Duluth-based Essentia Health.
Medicare was novel 12 years ago when it started penalizing hospitals on as much as 3% of their fee-for-service revenues if they readmitted too many patients. Today, it remains the most public example of numerous financial incentives for hospitals.
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