Rikki Moye isn't someone who chose nursing as a second or third career.
She wanted to be a nurse from the time she could talk, and for the past 33 years, that's what she's done.
About 10 months ago, the South Carolina native moved to Oklahoma to work at Midwest Regional Medical Center as the “director of resource management.”
Moye's title might not immediately convey what she does, but she is part of a movement affront in health care that's changing how patients receive care before and after they leave the hospital.
“It's an entirely different kind of nursing,” Moye said. “As a nurse on a floor, I can take care of a patient until the end of my shift. As a resource manager, I can take care of a patient long after they leave the hospital doors.”
Moye is in charge of Midwest Regional's efforts to reduce the number of patients who return to the hospital soon after they're discharged.
She said thanks to these efforts, Midwest Regional has seen a reduction in its readmission rate from about 24 percent to 18 percent in the past six months.
“Those statistics translate to me as souls,” she said. “Those are patients out there, and ... if a patient is being readmitted, that's telling me something is wrong.”
In Oklahoma, efforts to reduce 30-day readmissions in the last two years have prevented more than 3,000 readmissions to Oklahoma hospitals, which translates to about $29 million in cost savings to Medicare, according to estimates from the Oklahoma Foundation for Medical Quality.
These efforts relate to a provision in the federal health care law that penalizes hospitals if their readmission rates are too high.
Under the Affordable Care Act, or “Obamacare,” if the federal government deems a hospital's readmission rates too high — meaning these patients are coming in too soon after they've been discharged from the hospital — that hospital can lose some of its Medicare money.
Beginning this year, hospitals receive a payment reduction if they have too many 30-day readmissions for patients with heart attacks, heart failure and pneumonia, according to U.S. Health and Human Services.
This law changed has resulted in more than 2,000 hospitals in the U.S. forfeiting more than $280 million because of their readmission rates, according to Kaiser Health News.
Hospital payments account for the largest share of Medicare spending, and Medicare is the largest single payer for hospital services, according to the U.S. Department of Health and Human Services.
In 2009, more than 7 million people on Medicare experienced more than 12 million inpatient hospitalizations, according to the federal health agency.
One in three Medicare patients who leave the hospital today will be back in the hospital within a month, according to the agency.
These types of errors lead to “significant unnecessary health care spending,” with hospital readmissions costing Medicare an estimated $26 billion in 2009, according to the agency.
For the first year, hospitals were penalized up to 1 percent of the amount of Medicare money they received. Through the years, that percentage will continue to increase.
In Oklahoma, 90 hospitals faced an average penalty of .22 percent of their Medicare money, according to Kaiser Health News.
Midwest Regional Medical Center was one of the Oklahoma hospitals that was penalized the full 1 percent.
Other Oklahoma hospitals penalized 1 percent include Choctaw Memorial Hospital in Hugo, Eastern Oklahoma Medical Center in Poteau, Harmon Memorial Hospital in Hollis, Hillcrest Medical Center in Tulsa, Medical Center of Southeastern Oklahoma in Durant and Pushmataha Hospital in Antlers, according to Medicare data reported through Kaiser Health News.
To combat readmission rates, hospitals across Oklahoma and the nation are becoming more involved in what happens to patients after they leave.
Some hospitals are setting up follow-up appointments before the patient ever leaves the hospitals. Some have staff members who call patients a few days after they've left to check on them.
Tackling the issues around why a patient is readmitted isn't easy.
Moye said part of it, though, is sitting down with the patient and figuring out what's going on at home. These aren't easy conversations to have with patients.
Sometimes they cry.
Sometimes they say things like, “I had to pay the light bill so I couldn't have my prescription filled” or “If I take my pills every other day, I can make them last two months.”
Moye said she and other staff members connect patients who need financial assistance with different organizations, such as the United Way, that can help them with the problems they face.
“If you sit there with the patient and say, ‘This is your heart — Let's get your heart to where you can enjoy your life,' and you really and truly partner with that patient, then you're going to get levels of compliance that you've never gotten before,” Moye said.