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Outlook 2013: St. Mary's looks to cut readmissions

Saturday, February 16, 2013
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Memorial Campus Unit Coordinator Lynda Russell, left, and Director of Accute Rehab and Transitional Care Cheryl Palmatier stand at the nurses’ station in the new third-floor wing of the facility.
Photographer: Peter R. Barber
Memorial Campus Unit Coordinator Lynda Russell, left, and Director of Accute Rehab and Transitional Care Cheryl Palmatier stand at the nurses’ station in the new third-floor wing of the facility.

— When frail patients go right home not long after surgery, they run the risk of complications like infections, a situation that leads to more-costly readmissions.

In an effort to prevent this from happening, St. Mary’s Healthcare will be adding a new Transitional Care unit at the Memorial Campus this year.

The new unit is one of two additions planned for the campus in the town of Amsterdam — the hospital also plans to break ground later this year on a new Outpatient Pavilion costing between $15 million and $20 million.

The new Transitional Care unit represents an evolution that’s been ongoing since St. Mary’s acquired the former Amsterdam Memorial Hospital in 2009.

Changing with the times — which includes goals to reduce nationwide healthcare costs — is an ability that keeps the Amsterdam healthcare institution busy as the largest employer in Montgomery and Fulton counties, with roughly 1,600 people employees, including part-timers and per-diem staff.

The 11-bed Transitional Care unit will be situated on the third floor, near the 10-bed acute rehabilitation unit.

Dr. John Fedullo, who will direct care there, said transitional care gives post-operative patients another option rather than taking the risk of going home, traveling out of town for rehabilitation services or being placed into a nursing home.

“You can put that patient in kind of the right slot to succeed,” Fedullo said.

He describes the type of care as a way to “decrease barriers to return back into the community” by preventing complications after surgery and allowing patients to begin some rehabilitation that’s not as intensive as acute rehab that requires three hours of therapy a day.

The service will helps keep patients in their community, as opposed to having to travel elsewhere for post-operative rehabilitation.

With current regulations, many patients don’t qualify for acute rehabilitation under Medicare regulations. Sometimes, these patients go home and risk post-operative infections, blood clots or other complications.

“It poses increased risks to the patients,” Fedullo said.

The effort to adequately describe the needs of these patients has taken about four years, Fedullo said, and success with a Certificate of Need application through the state Health Department shows the Transitional Care unit addresses a gap in the healthcare system.

Following total knee replacement surgery, a 60-year-old patient is no longer eligible for acute rehabilitation under Medicare regulations — rule changes implemented over the past decade are aimed at decreasing people’s access to those services. The Transitional Care unit adds a layer of service that is eligible, Fedullo said.

“This is where we’ve gotten creative and cutting-edge, to then design a capacity for those patients,” Fedullo said.

In terms of business, keeping people from returning to a hospital bed after surgery also limits the hospital’s financial liabilities. Fedullo said Medicare issues penalties to hospitals when patients are discharged, only to return.

A Transitional Care unit will give doctors and other medical staff sufficient time to “fine-tune” each individual patient’s care.

“If you had five or 20 more days, than you can look at other intermediary factors in that patient’s case,” Fedullo said.

They include proper training on a new oxygen machine, for example.

There was a lot of space in the Memorial Campus facility right after the unification of the two hospitals, Fedullo said, but now it’s blossoming to the point where there isn’t a lot of extra space. A unit that once served as the pediatric center, then a wound care center, is being transformed into the new Transitional Care unit.

Its location adjacent to the acute rehab unit makes it easier to maintain contact with patients as they heal.

The new unit will include 11 private rooms, a dining area and an activities area.

“We can share resources with the acute rehab so that we can synergize and kind of deliver similar programs to house transitional care patients,” Fedullo said.

Staff to be stationed at the Transitional Care unit are rotating through work in the acute care unit. It will take about six people, mostly registered nurses, to staff the site.

The state Health Department approved the project, estimated to cost $350,000, last summer.

Meanwhile, the new outpatient pavilion will include medical imaging, comprehensive cancer care and laboratory services in a new 34,000 square-foot building to be built on the Memorial Campus.

 
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