Penn researchers inform health care reform debate

While current health care reform efforts seem distant - with most discussions based in Washington, D.C. - Wharton, the School of Medicine and the School of Nursing are playing a significant role.

A team of researchers from these schools has demonstrated that significant costs would be saved if Medicare provided for treatment after a patient's initial hospitalization. This research has become the basis for the Medicare Transitional Care Act, which is currently being discussed in the House of Representatives.

Led by Nursing professor Mary Naylor, the research aimed to eliminate preventable hospital readmissions that occur each year to senior citizens with chronic illnesses.

By providing high-quality transitional care to high-risk Medicare beneficiaries, this model would save potential costs by providing the care and medication necessary to sustain high-risk patients when they leave the hospital - avoiding a relapse.

Wharton professor Mark Pauly, one of the members of the research team, said the research was based on strong evidence derived from randomized controlled experiments that proved causation, not just correlation, between additional post-hospitalization care and reduced costs.

Sponsored by Representatives Earl Blumenauer (D-Ore.) and Charles Boustany (R-La.), the act has been introduced in the House and approved for funding by the Senate Finance Committee.

If the act passes, $500 million would be allocated to eligible hospitals and community-based partnership organizations beginning in 2011 to provide transition services to high-risk Medicare beneficiaries.

The bill would have a significant impact on reducing the costs and pain of the sufferers of chronic illness, which Naylor described as "an epidemic in the United States."

At the moment, there is no way to receive Medicare reimbursement for the costs of hospital readmission or further treatments and care after initial treatment.

By creating a Medicare allowance for post-hospitalization care, costs would be significantly decreased for these patients - by an average $5,000 a year.

Nursing professor Kathleen McCauley, who was also involved in the research, described the model as a "cost-effective strategy with a very great future."

Under the legislation, Medicare would provide funds for a "transitional care clinician" - generally an advanced-practice nurse - for services such as developing a transitional care plan that identifies potential health risks, treatment goals, current therapies and future services.

"It's hard to imagine a violent backlash, as has been the case with other health reform debates taking place," said Pauly. "If there's any logic to politics, this bill will certainly come through."

Having just presented their research to the Senate Finance Committee last weekend in Washington, D.C., Naylor is optimistic about the bill's future.

"I am hopeful that it will have sufficient impact to change the health care system in general," said Naylor.

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