"My wish was simply to make it through the operations," says the petite grandmother from Feasterville. "The recovery was very painful. I worried that I might never walk again."
Henion's progress and those of other Medicare patients are being closely monitored by Holy Redeemer Hospital, which, like other facilities, is working to avoid new federal penalties that reduce their Medicare payments for patients who are readmitted within 30 days.
Last year, under federal health reform, a maximum one percent fine on Medicare payments was levied against hospitals whose readmission rates for patients with heart failure, heart attacks, and pneumonia exceeded federal guidelines. Holy Redeemer in Meadowbrook and St. Luke's Quakertown Hospital were the only ones in the region to avoid incurring penalties.
Next month, penalties will reach a maximum of two percent, and will rise to three percent in October 2014. Conditions covered will also be expanded to include chronic obstructive pulmonary disease and hip and knee replacement.
"Every hospital across the country is looking how to reduce readmissions," says Karen Renson, Holy Redeemer's chief quality and safety officer. "We like to think about the issue through a patient's perspective: no patient wants to be in the hospital, nor does a patient's family want them to be there."
"Our programs are not designed in response to Medicare penalties; we simply all need to do better jobs around all transitions in care," says Cass Egan, chief administrative officer.
To reduce avoidable readmissions, Holy Redeemer - more than its hospital peers - has established a broad system of home health and hospice care, maintaining a large presence in New Jersey, while also covering Philadelphia, Bucks, and Montgomery Counties in Pennsylvania.
Patient education is at the core of the programs. For Henion's recent knee replacement, that meant a two-hour preadmission class that covered preparing for surgery, preventing blood clots, using new medications, assistive equipment a patient can use, and what the patient can expect during hospitalization and after discharge.
Once in the hospital, there are interventions designed to improve continuity of care. One recent addition is the inclusion of a pharmacist to a multidisciplinary team of doctors who regularly visit patients. The goal is to make certain that patients leaving the hospital understand how to take their medications.
"If you talk to a patient about medications, they'll sit and nod and their families will nod. You think you're being clear, but it's a stressful time," says Egan. "Having the pharmacist to answer questions can avoid confusion."
After her knee operation, Henion moved to home health care, which included daily physical therapy and a home inspection to check for possible hazards, including throw rugs and loose banisters. Therapists also inspected her incision site for infection.
Patients without adequate support at home may move from a hospital bed to the Transitional Care Unit, where they can spend seven to 10 days recovering from surgery, receiving therapy, and practicing life skills such as walking, showering, and dressing.
There is also the option of a new Safe Transitions Program, a private pay service in which a home health aide accompanies a patient home to make certain he or she is settled appropriately on the first day out of the hospital. Aides ensure that patients have the correct medication, shop for necessary supplies, and provide support before a more extensive home health program kicks in.
"We're hoping that this program helps," says Renson. "When you talk to patients about what it is we can do better, we've learned that the first day home from the hospital tends to be very challenging."
For Henion, the continuity of care has paid off. Since leaving the hospital, she has undergone only a single outpatient procedure to help increase the flexibility of her leg, a key sign for knee replacement patients.
Shortly after surgery, Henion could bend her leg only 65 degrees, but now, thanks to the gym and stretching therapy, her range of motion has increased to 120 degrees. She has weaned herself off pain medications, and though she isn't yet climbing ladders or doing heavy housework, she dreams of getting back to country-and-western dancing with her husband, Robert.
"I was a big baby," says Henion. "I told my husband again and again, 'It hurts.' I swore that I would never go through another surgery. But now I know I'm going to get better. I'm so glad I did it."
Ilene Raymond Rush can be reached at firstname.lastname@example.org