Since she was diagnosed with heart failure earlier this year, Betty Winstead, 84, has become a familiar face at Carney Hospital. Her medical team has taken all the conventional steps to keep her from returning, but nothing has broken the distressing and costly cycle of home to hospital and back.
Last Monday, Steward Health Care launched a new approach for Winstead and patients like her.
The hospital company hired City Fresh Foods to deliver three low-sodium meals and two snacks to Winstead’s Mattapan home each day, free to Winstead. Doctors hope healthy food such as berry granola, bean and kale burritos and sweet and sour tofu will ease her symptoms — and cut down her trips to Carney.
“We really want to make a lifestyle change for the patient,’’ said Dr. Lana Tsao, director of advanced heart failure and the coronary care unit at St. Elizabeth’s Medical Center, which, like Carney, is owned by Steward. “Patients will say “I don’t want to change my diet. I have been eating this way my whole life.’ The problem is they have been eating that way their whole life.’’
Steward is spending $66,000 to buy food for one month for 55 heart failure patients, focusing on a disease with one of the highest readmission rates. One-quarter to one-third of these patients land back in the hospital within 30 days of being sent home, and many physicians believe too much salt is one culprit.
Nurses are signing up patients at Carney and St. Elizabeth’s, both in Boston, and at Saint Anne’s Hospital in Fall River, also part of Steward. So far, Winstead said the meals “taste all right’’ but that it’s too soon to tell if they will make her healthier.
Strawberry oat squares and sweet potato chips with hummus may seem like needless expenses for hospitals perpetually struggling to make ends meet. But if Steward reduces readmissions by even a small amount, the dollars will be well-invested, executives said.
Carney, St. Elizabeth’s, and Saint Anne’s were among the 2,000 hospitals nationwide penalized last year by the federal Medicare program because too many seniors were readmitted — which can be a red flag for poorly coordinated and overly expensive care. St. Elizabeth’s and Saint Anne’s lost the maximum allowed under the federal health care law: 1 percent of their base Medicare reimbursements.
Steward executives would not disclose the amount of the penalties.
Doctors working to reduce readmissions at other hospitals are eagerly awaiting results from the Steward experiment, they said.
“I don’t know of any data that suggests it’s a slam dunk,’’ said Dr. Karen Joynt, a cardiologist at Brigham and Women’s Hospital and the VA Boston Healthcare System. But “one thing we need more of in health care is innovation. If it works, terrific. Thinking beyond the hospital’s walls is a good thing for patients.’’
As payments to providers become increasingly tied to quality and their ability to hold down costs, hospitals have begun sending nurses and pharmacists into patients’ homes to try to lower readmissions. They inspect homes for hazards that could cause falls, check for allergens that contribute to breathing difficulties, and monitor medication regimens.
These programs typically haven’t focused on diet, even though doctors recognize the strong link between food and health, especially when it comes to heart disease.
Boston Medical Center was alone when it opened the first hospital-based food pantry in 2001. Doctors write “prescriptions’’ for patients, who can take home enough food to feed their families.
Dr. Ravin Davidoff, chief medical officer at BMC, said the hospital has not studied the pantry’s impact on hospital readmissions. “We just do this because we know our patients need it so desperately,’’ he said.
But the idea could spread.
At Newton-Wellesley Hospital’s Vernon Cancer Center, social workers noticed last year that some patients were not eating enough because of nausea, appetite loss, or financial constraints. Some lost weight, suffered dehydration, and were hospitalized.
“Their ability to withstand additional rounds of chemotherapy is compromised,’’ said Christina Chiu, a dietician at the cancer center. If the doctor has to delay treatment, “that creates bigger issues.’’
The hospital hired Healthy Habits Kitchen in Wellesley to deliver four to five meals, each with four to six servings, a month to patients who qualify for the program. “On especially rough days, they can reach into the freezer and grab something,’’ Chiu said.
“Even if we can prevent one ER visit, that more than pays for three months of meal deliveries,” she said.
Along with the Medicare penalties, insurers are imposing new limits on how much hospitals can charge for treating patients.
“We’re aiming to better manage patients in the places they are the most, which is their homes,’’ said Dominique Morgan-Solomon, director of care management for Steward. “We want to see an impact in the 30 days but also a longer return on investment. Nutritious food is very much correlated with better health outcomes.’’
In the case of congestive heart failure, there is some evidence that a low-sodium diet may prevent the trademark accumulation of fluid in the lungs, which leads to breathing problems and dizziness — and trips to the emergency room.
In addition to the meals, which limit salt to 1,500 milligrams per day, Steward patients will receive recipes and extra nutritional counseling. “We don’t want to leave our patients in the lurch’’ after the 30 days are up, Tsao said.
Eventually, managers will compare readmission rates for patients who received City Fresh food to heart failure patients who did not participate in the program. The goal is for the former group to have an average readmission rate that is 25 percent lower than the control group.
It’s an ambitious goal in part because not all heart failure patients are sensitive to salt, Joynt said. And while staff on the cardiac unit who taste-tested the meals gave them a thumbs-up — “very flavorful’’ said nurse manager Sarah Blanchard — it’s unclear whether hot dogs and egg salad made of tofu will appeal to patients of various ethnic backgrounds and income levels.
Joynt also wonders what will happen after the meal deliveries are over.
Unless a relative has brought over dinner, Winstead and her husband will eat at a restaurant — where food is notoriously salty — because she is too tired from her disease to cook.
“I am not feeling good most of the time,’’ she said.
That fatigue is unlikely to disappear when meal delivery stops.
Her niece, Mary Hanzer, who recently visited from Delaware, worries about her. Hanzer noticed during their daily telephone calls in January that her aunt took constant breaks because she couldn’t catch her breath.
Winstead has been hospitalized four or five times in the last month alone, Hanzer said.
“I cook for her and her husband when I’m here,’’ she said.
As for the City Fresh meals, Winstead enjoyed the shrimp scampi, the “egg’’ salad sandwich, the pancakes, and the strawberry oat squares, said her daughter, Tanya Jones. As of last Wednesday, she had not yet tried the garden or spinach salads or the bean and kale burrito.