30-Day Readmissions: A Case Study

In 2011, there were approximately 3.3 million readmissions to hospitals, raising healthcare costs and negatively impacting patient health. Two important contributors are discharge planning and education. Many patients do not receive enough of either, and are sent home misinformed about their diagnosis and medications. In order to decrease readmissions, hospitals should utilize interactive patient systems to educate patients while they are in the hospital. This will increase patient knowledge of their diagnosis, as well as make it easier for nurses to go over discharge teachings with the patient. This gives

As consumers utilize smartphones, tablets, and other devices for other functions like social media and email, they are starting to look at these features to assist them with their healthcare. Mobile body area network devices will be a growing trend in the coming years as a way to get patients engaged in their healthcare and also to give providers routine updates on the status of patients with chronic conditions. As DeGaspari (2014) indicates, these devices can lead to improved functionality for other devices used in hospitals, such as sensors for monitoring patients that might get up and wander or be a fall risk. Telemedicine will continue to grow as payers, providers, and patients all start to realize the mutual benefits that can be

Unfortunately, along with the good must come the bad. For every positive aspect of smartphones and social media in healthcare related settings, there is an equally negative aspect. One pitfall of smartphones in healthcare is directly related to one of the positive aspects of smartphones: the availability of medical

The Affordable Care Act was enacted to improve health care and to lower health care cost in America. The ACA developed different strategies to meet these goals called the “pay for performance” programs. These strategies are aimed at the different providers to improve quality care. The strategy that I selected is the “Hospital Readmissions Reduction Program” this program/strategy is also known as the HRRP and was begun in October of 2012. HRRP is aimed at hospitals and penalizes hospitals that have a high 30 day readmission rate. The penalties are assessed and based on a number of comparisons, those such as, performance, patient demographics, comorbidities and frailty.

This memorandum describes Central Health’s Readmission Reduction Program set to commence in May 2017. The Centers for Medicare and Medicaid Services (CMS) has raised concern over the increasing readmission rate and poor quality of care. To address this issue, Congress has created Hospital Readmission Reduction Program (HRRP) statute under the Affordable Care Act, 2010, which was recently updated under 21st Century Cures Act of 2016. Under the constant pressure of a penalty, Central Health has considered to establish its own Hospital Readmission Reduction Program to address specific imperatives, such as care-coordination, treatment adherence program, and streamlined patient discharge process.

Policy makers created the Medicare Hospital Readmissions Reduction Program (HRRP) in an attempt to improve quality of patient care and lower costs (James, 2013). In order to avoid these penalties, healthcare leaders must recognize that CMS has identified a correlation between readmissions and a lack of quality care. Therefore, the aim is not to focus solely on hospital readmissions, but to seek clinical excellence by investing in quality improvement (Silow-Carrol, Edwards & Lashbrook, 2011). However, reducing readmissions is a complex undertaking, because not all readmissions can or should be prevented. Indeed, some readmissions are planned as part of sound clinical care. Furthermore, while hospitals work to reduce readmissions caused

The health care organizations have big opportunity to improve their quality of healthcare service as well as improve life quality of customers through reducing an avoidable readmission. The readmission is defined by Centers for Medicare and Medicaid Service (CMS) “Admission to a subsection hospital within 30 days of a discharge from the same or another subsection hospital” Hoffman, J.H. (2012). Readmissions can be classified four different categories, including (1) Planned readmission which the reason of the readmission is related to the initial admission. For example, reconstructive surgery with subsequent steps or it could be series of treatment such as cancer chemotherapy. (2) Planned but the reason is not related to the initial readmission.

In my current position, the Hospital Readmission Reduction program plays a pivotal role in my job. I am a part of a new initiative in conjunction with NexusMontgomery. “This program aims to provide care management intervention that will reduce overall hospital costs and reduce hospital admissions and readmissions in Montgomery county Maryland” (Regional Trans, 2015, p. 1). Funding is provided from The Center for Medicare and Medicaid Services. The program aims to significantly reduce the number of residents in Montgomery County with hospital admissions and readmissions. The targeted population are seniors 65 years and older. The client must have Medicare and reside in an eligible Montgomery county zip code. The program will reduce hospital

The Center for Medicare and Medicaid Services (CMS) have proposed policies that will penalize healthcare organizations for the increasing readmission rate related to patients who has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). This readmission policy is part of the CMS Hospital Readmission Reduction Program (HRRP) which was enacted to further address the diminishing quality of health care services and to curb the rising cost of health care services by providing financial incentives to healthcare organization in order to promote gravitation toward Accountable Care Organizations (ACO) or Managed Care Organization (MCO). The main objective of levying reimbursement penalties on healthcare organizations is to move away from the fee-for-service method of reimbursement toward a patient-centric, and disease management approach where healthcare services are coordinated not just in the acute phase of disease, but also in the chronic of phase disease.

In my current role a President of our integrated care network, one are largest cost outliers in our Medicare cost report was our 30 day readmission rate. The government has defined 30 days as the time period they feel a patient should be not readmitted to a hospital for certain diagnoses. Studies have looked at the groups that have had intervention in terms of discharge planning, and those with no intervention or discharged in a "usual" fashion from an institution. A study in the journal Circulation in 2013 looked at this exact question and found that following certain protocols could reduce the readmission rates in heart failure patients (Bradley, et al., 2013).

According to Dharmarajan et al. (2013), 67.6% of all AMI readmissions occur in the first 15 days following discharge from the hospital. Arai (2015), posits that the ability to intervene in MIs has focused attention on the first few hours after the attack thus detracting from the cognizance that the healing process is more complicated and prolonged usually requiring at least five to six weeks and thus believes that the term MI should be preceded by acute, healing, or healed to describe the phase in which the patient is in. Although the highest number of readmissions occur soon after hospitalization, more than 30% of readmissions within the first 30 days occur during days 16 through 30 implying that the patient is at risk for the entire 30-day

Devising ways to implement strategies to reduce hospital post-discharge readmission rates of patients is vital. It has been estimated that Medicare beneficiaries in America, who are readmitted within 30 days of discharge costs $15 billion per year (Bradley et al., 2013). In particular, reducing the 30-day readmission rates of the elderly population is imperative. As nurses’ we need to be aware of the importance that communication and teamwork, among the whole inter-disciplinary team, has on client care. Further research would be warranted and should include retrospective longitudinal studies in actual healthcare settings. Moreover, this would serve as a means to assess the effectiveness in the delivery of safe and effective

Our market strategy will be direct contact with the target audience. Members of the Vision Casters will make appointments with hospital administrators, as well as health providers such as Cardiologists that practice at the targeted hospitals. There are 50 hospitals in the San Bernardino

For years, healthcare costs have continued to increase in the United States and policymakers are constantly trying to find ways to reduce spending. According to reports, in 2011, about $900 billion out of the $2.6 trillion annual health care spending was wasteful spending. In the following year, there was a reported $690 billion wasted annually on healthcare. This wasteful spending is attributed to ineffective health care delivery, cost of adverse events, and poor care coordination that has led to avoidable readmissions (Lallemand, 2012). In the United States, readmissions are the highest amongst patients with chronic diseases accounting for about 90% of avoidable readmissions in 30 days after discharge, and costing the industry an estimated $17 billion. These readmissions are a result of inadequate discharge planning, lack of follow-up, and lack of education on disease management (Jayakody et al., 2016). Policymakers on the federal and state level have developed and implemented several programs, some varying state to state, to help reduce wasteful spending while improving quality of care.

“Might a computer be less likely to discriminate on the basis of these and other social characteristics? However, what is lost when the human dimension is subordinated to computer technology in medical decision making?”(pg 504) Those are just two of the many questions that concern sociologists. We must understand that technology continue to advance and that change is not always accepted at first, especially in the medical field. It will take time for the entire public to accept the new system and understand that it is truly beneficial to health care workers around the world.