To Prevent Repeat Hospitalizations, Talk To Patients

To Prevent Repeat Hospitalizations, Talk To Patients

5:00pm Sep 29, 2014
Kevin Wierhs and Susan Johnson confer about what works and what doesn't in managing diabetes.
Kevin Wierhs and Susan Johnson confer about what works and what doesn't in managing diabetes.
Sarah McCammon / Georgia Public Broadcasting

Kevin Wiehrs is a nurse in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson.

Kevin Wierhs and Susan Johnson confer about what works and what doesn't in managing diabetes.

Kevin Wierhs and Susan Johnson confer about what works and what doesn't in managing diabetes.

Sarah McCammon/Georgia Public Broadcasting

Johnson, 63, is a retired restaurant cook who receives Medicare and Medicaid. She has diabetes, and has already met with her doctor. Afterward, Wiehrs spends another half-hour with Johnson, talking through her medication, exercise and diet.

"So it sounds like you cut back on your sweets, things that have a lot of sugars in them. What about vegetables, your portions of food?" Wiehrs asks Johnson. "Have you made any changes with that?"

"A little bit," Johnson says. "Ain't gonna lie — a little bit."

Wierhs, 51, was a hospice nurse for 15 years and a social worker before that. Now he is one of five new care coordinators at Memorial Health, a medical system based in Savannah. He was hired to pay special attention to patients with poorly controlled chronic conditions like diabetes and heart disease.

"Some of these patients have fought with their diabetes for many years and get very complacent with the whole situation and feel that, 'No matter what I do, it's not going to make a difference,' " he says. "But it does."

It's hard to persuade people to change, Wiehrs says. And patients are sometimes skeptical about his role in their care. He says they often approach him and say, "I've been coming to this office before; I've seen these physicians. And now you're somebody new. What are you doing, and why do you want to talk to me?"

Getting these patients to trust Wiehrs is an important part of the hospital's strategy for dealing with rising costs. Memorial is investing $500,000 a year in care coordination, in the belief that the program will save money in the long run and improve the quality of care.

Memorial CEO Maggie Gill wants Wiehrs to teach patients to care for themselves.

By improving the management of medical conditions outside the hospital, Gill says, "you can help people prevent crises from happening."

She says Memorial provides about $30 million in free care each year. Because Georgia is not among the states that have chosen to expand Medicaid under the Affordable Care Act, the hospital is going to continue to give a lot of free care to people who have low income and are uninsured, Gill says. On top of that, Medicare is penalizing hospitals (via lower reimbursements) when patients have to be admitted repeatedly for some specific conditions. Gill hopes Wiehrs can prevent some of those repeat visits.

Gill recalls one Memorial care coordinator who helped with a particularly difficult case — another patient with diabetes who tended to show up in the emergency department two or three times a year. Working with the patient's wife until she felt comfortable measuring her spouse's insulin levels, and comfortable delivering insulin, made a big difference.

"They avoided at least two emergency department visits by having that resource," Gill says.

On a typical day, Wiehrs meets with three or four patients and calls people who have just been released from the hospital.

He says patients end up trusting him. He makes sure they're feeling well, taking their medication and that they know when to come in for a follow-up. Wiehrs gives them his direct phone number so they don't have to hassle with the front office. And for those who can't afford their medications, Wiehrs says, he'll call drug companies or do research online to help find discount drug programs.

"Sometimes you have to get creative and you have to spend the extra time to see what might be available," he says. "That's the benefit of me being a care coordinator and having the experience that I have. I know how to navigate the health care system."

Wiehrs says he's encouraged by the results he's seeing already — like the patient who practically bounded into his office recently, breathing easier thanks to new asthma inhalers.

The hope is that lots of little improvements like that will add up to big savings to the health system — and will improve the health of patients.

This story is part of a reporting partnership that includes Georgia Public Broadcasting, NPR and Kaiser Health News.

Copyright 2015 Georgia Public Broadcasting. To see more, visit http://www.gpb.org/.

Transcript

STEVE INSKEEP, HOST:

Now let's talk about an old industry that's hiring a new kind of worker. Health providers are hiring people whose job is to make sure you do not need to go to the hospital. Sarah McCammon reports from Georgia Public Broadcasting.

SARAH MCCAMMON, BYLINE: Kevin Wiehrs is a nurse at a busy doctor's office in Savannah, but instead of giving patients shots or taking blood pressure readings, his job is mostly talking. Today he's meeting with Susan Johnson, a 63-year-old patient with diabetes.

KEVIN WIEHRS: Your lab work definitely showed some improvement.

SUSAN JOHNSON: Yes.

MCCAMMON: Johnson is a retired restaurant cook who receives Medicare and Medicaid. She's already met with her doctor, but Wiehrs spends another half hour with her, talking through her medication, exercise and diet.

WIEHRS: Well, it sounds like you cut back on a lot of your sweets and things that have a lot of sugar in them. What about, you know, vegetables and your portions of food? Have you made any changes with that?

JOHNSON: A little bit. I ain't going to lie - a little bit.

WIEHRS: (Laughter). OK.

MCCAMMON: Wiehrs is 51 years old, but he looks younger. He has a few flecks of grey in his neatly trimmed beard. He was a hospice for 15 years and a social worker before that. He's one of five new care coordinators at Memorial Health, a medical system based in Savannah. He's paid to pay special attention to patients with poorly controlled chronic conditions like diabetes and heart disease.

WIEHRS: Some of these patients have, you know, fought with their diabetes for many years and, you know, get very complacent with the whole situation and feel that, well, you know, no matter what I do, it's not going to make a difference. But it does.

MCCAMMON: It's hard to persuade people to change, Wiehr says. And patients are sometimes skeptical about his role in their care.

WIEHRS: I mean, who are you? I mean, I've come to this office before, I've seen these physicians, and now you're somebody new. And what are you doing? Why do you want to talk to me?

MCCAMMON: But getting these patients to trust Wiehrs is an important part of the hospital's strategy for dealing with rising cost. Memorial is investing half-a-million dollars a year in care coordination, in the belief that it will save money in the long run. Memorial's CEO, Maggie Gill, wants Wiehrs to teach patients to care for themselves.

MAGGIE GILL: You can help people prevent crises from happening by helping them manage them outside of the hospital.

MCCAMMON: Memorial provides about $30 million in free care each year. Because Georgia is not expanding Medicaid under the Affordable Care Act, Gill says the hospital is going to continue to give a lot of care for free. On top of that, the federal government is penalizing hospitals for some repeat visits. Wiehrs, Gill hopes, can prevent some of them.

GILL: A particularly difficult diabetic patient ended up in the emergency department, typically, two or three times a year. And with the help of the care coordinator, the wife was now feeling more comfortable in delivering insulin and measuring insulin levels. And they avoided at least two emergency department visits by having that resource.

MCCAMMON: On a typical day, Wiehrs meets with three or four patients, and calls people who've just been released from the hospital.

WIEHRS: How are you feeling today, sir? OK, awesome. I'm the RN care coordinator here at the office. And I was calling to follow up with you since you were discharged from the hospital the other day.

MCCAMMON: Wiehrs says patients end up trusting him. He makes sure they're feeling OK, taking their medication, and know when to come in for a follow-up. He gives them his phone number so they don't have to hassle with the front office. For those who can't afford their medications, Wiehrs says he'll call drug companies or do research online to help find discount drug programs.

WIEHRS: Sometimes you just have to get creative. You have to spend the extra time to see what might be available. That's the benefit of being a care coordinator and having the experience that I have as a nurse - is that I know how to navigate the healthcare system.

MCCAMMON: Wiehrs says he's encouraged by the results he's seeing already, like the patient who practically bounded into his office recently, breathing easier thanks to his new asthma inhalers. The hope is that a lot of little improvements like that will add up to big savings to the health system in the long run.

For NPR News, I'm Sarah McCammon in Savannah, Georgia. Transcript provided by NPR, Copyright NPR.

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