Affordable Care Act - Medicare 's Readmission Reduction Program

This is an opportunity for hospitals to work more closely with skilled nursing facilities and other post-acute providers to improve care transitions, and experience fewer readmissions. The ACA impacted hospitals by holding back a one percent reimbursement rate. Hospitals will actually need to perform and deliver high-quality evidenced based care to recover the one percent withheld reimbursement rate while hospitals that exceed the benchmark, will received a higher reimbursement rate over the one percent. The Act is intended to help spur the trend of more integrated care throughout the continuum. The Affordable care act (ACA) of 2010 designed programs for improvements and innovation in the quality of hospital care by instituting the Medicare’s hospital readmission reduction program. Through this program, CMS reduces Medicare payment bt one percent for hospitals for hospitals that demonstrated high rate of avoidable readmissions for patients with a diagnosis of heart failure, heart attack

Furthermore, the United States spends nearly double the average $3,923 for the 15 countries ("Health Care Cost," 2011).” Accordingly the U.S. throws away more money than any other country on healthcare which consequently could jeopardize the medical attention that is being provided.

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

The United States spend entirely to much money on health care compared to other industrialized countries. Yet, other countries achieved far better health for more people at less cost, according to OECA. Of the 34 countries rated by the OECD study, the United States ranks #1 in health care spending per capita and #1 in percentage

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

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.

Your hospital will be penalized if you get readmitted within 30 days because of the chronic disease mismanagement. The Affordable care act (ACA) has changed the perspective of chronic disease management of hospitals, shifting their focus from treating the conditions to deciding ways to prevent them. Under ACA, hospitals will be penalized or rewarded depending upon their performance on 30-day readmissions, infection control and patient satisfaction levels (1). Government is playing his role to reduce the burden of chronic diseases in society but being a responsible citizen, do we realize the intensity of situation and the economic instability it is causing?

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.

Partnership for Patients (PfP) has made significant progress in decreasing the number of preventable hospital acquired conditions (HACs), hospital readmissions, hospital patient deaths, and health care expenditures. Nonetheless, much work remains to be done so that PfP is more effective in their mission to make and improve care safety and care transitions. The progress made is part of a program that has been in effect since April of 2011, soon after sections 3011 and 3026 of the Patient Protection and Affordable Care Act (PPACA) were signed into law. These sections allowed then Department of Health and Human Services (DHHS) Secretary, Kathleen Sebelius, and Center for Medicaid and Medicare Services (CMS) Administrator, Donald Burwick, to create and provide funding through Medicare for a dual program to reduce hospital readmissions and transition care services.

The fact is that the U.S. spends more money on health care than any other country in the world, even when adjusting for relative wealth, according to a 2008 study by Mkcinsey Global Institute (MGI). In 2012 that number was about 2.6 trillion dollars or 18.6% of their gross domestic product (GDP) (13), in other words the U.S. spent about 8,915 dollars per person on health care, or more than twice what they spent on food and more than China spent on all goods and services combined (See Figure 1, MG1 2008). The amount spent on health care is expected to continue to rise , though that rise has slowed in the last three years, estimates suggest it could reach nearly 4.8 trillion dollars by 2021; which would be roughly one fifth of the U.S. GDP (15)

In 2003, health care spending reached 1.7 trillion dollars and 1.8 trillion dollars in 2004. That is 4.3 times the amount spent on national defense in this country. (California Health Care Foundation, March 02, 2005, Health care costs 101).

In an effort to curb these costs, in 2013 the Center for Medicare and Medicaid Services (CMS) enacted the Hospital Readmissions Reduction Program. Under this program, hospitals are penalized for readmissions occurring in the first 30 days. The penalties apply to specific conditions for CMS recipients including acute myocardial infarction, heart failure, coronary artery bypass graft

The U.S. spends more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. 10 of the 20 occupations

In the year 2012, expenditure on US health care amounted to 2.8 million trillion dollars, accounting for 17.2 percent of the total Gross Domestic Product (GDP) of the US. The annual average cost of health care for the characteristic American family of 4 amounted to more than

To overcome this serious readmission rate problem, Center for Medicare and Medicaid services (CMS) imposed huge penalties on the hospitals, which had serious readmission rates (Amarasingham et al., 2010). Furthermore, most of the developed country governments devoted high importance to identify the patients who are at high risk of readmitting so that hospitals can plan the patient pathways. According to (Demir, 2014) they are: