The fourth installment of NY1's series on the Affordable Care Act takes a look at how the law tries to essentially reorganize the way care is delivered. NY1's Erin Billups profiles one city hospital's efforts to bring down re-admission rates through increased coordination between health care providers.
A myriad of chronic health issues in 2010 meant six hospital stays in six months, on top of several emergency room visits, for 59-year-old Lawrence Smith.
"I have a heart problem and I have a kidney problem," Smith says.
Smith was flagged as high risk for readmissions by Mount Sinai Hospital's Preventable Admissions Care Team, called PACT.
"We created a model where the social workers go and interview patients, and it's a very in-depth assessment," says Dr. Jill Kalman, medical director of PACT. "It might be income, health literacy, issues in the home, issues around family that may be returning patients to the hospital."
For five weeks after being discharged, a PACT social worker was in regular contact with Smith. They helped him find day care for his toddler granddaughter, get a cellphone and transportation to dialysis, and accompanied him to doctor appointments.
"People can't deal with those things until the stress of everyday life is sort of alleviated," says Yael Ramer, Smith's Mount Sinai social worker.
PACT was started shortly after the Affordable Care Act passed in 2010, partly to avoid the new federal penalty for large numbers of re-admitted patients.
"We've had results where we're able to reduce 30-day readmissions by about 40 to 50 percent," Kalman says.
Mount Sinai is one of many Accountable Care Organizations, or ACOs, cropping up across the country. It's part of the reform law's shift away from fee-for-service care, focusing more on proactive, preventative care.
"You absolutely have to change the framework," Kalman says. "We can't have patients utilizing emergency rooms and utilizing hospitals as their health care. And we also want to be able to approach patients when they're at risk of these diseases."
The ACO model is mainly an effort to control Medicare costs. There are still concerns surrounding the new approach, one being the availability, or lack thereof, of primary care doctors.
For Smith, however, the improved coordination between his health care providers means he's now able to live a more healthy, productive life.
"Before, I felt like it was, like, the end for me," he says. "Now that things is getting better, I feel that I'm going to live."