Application Theory

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

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

This paper will describe current quality outcome measures and the significance for improving medical care. Organizational accountability and transparency has improved with the emergence of Hospital Inpatient Quality Reporting (IQR) programs and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs). This article will review the role of the nurse manager in creating a culture for quality care as well as the nurse for meeting organizational and patient expectations. Organizations like The Joint Commission (JC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), and The American Nurses Association (ANA) have been critical in establishing standards for quality. This paper will also report on the most recent hospital statistics and steps taken to improve HCAHP scores and reduce readmission rates at the University of Tennessee Medical Center in Knoxville (UTMCK). Statistics at UTMCK will also be compared to the Tennessee and National averages found on the Medicare website Hospital Compare. The aim of this paper is to explore if healthcare system initiatives are improving quality and enhancing patient outcomes.

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.

In 2013 readmission following hospital stays for AMI, CHF, COPD or pneumonia the cost for readmissions totaled $7.0 billion, which accounted for 13 percent of the cost for total readmissions in the nation (Fingar & Washington, 2015). The highest readmissions fell with HF, followed by COPD, pneumonia then AMI. Trends from 2009-2013 showed a decrease in the overall hospital Medicare readmissions by an average of 9 percent and this was from these top four diagnosis (Fingar & Washington, 2015). This information came from Healthcare Cost and Utilization Project (H-CUP) which is a group of healthcare data bases. Through technological use of several software tools the data needed for this project was abstracted. This is a perfect example of using technology to improve the processes for healthcare improvement by supplying needed data for analyzing to gain the knowledge for change within the healthcare systems (Fingar & Washington, 2015).

contribute to the costly effect include the fact that nurses have, increased incidence of nurse burnout and patients have poorer outcomes increasing both mortality and readmission rates. Nurses are a large component to keeping readmission rates down through spending time with a patient and educating and empowering patients on self-care through helping patients understand importance of medication regimen adherence, importance of diet adherence, ways to reduce infection and various other skills to care for self at home" (Problem Memorandum Assignment, 2015) The documents exigence is crucial the audience to better the outcome of patients and that of the health

One common theme that has resurfaced throughout the entire Obama administration and has created a great deal of focus and debate is health care reform. The Patient Protection and Affordable Care Act (PPACA) which was introduced by Obama in 2010 creates a new structure of health care. It transforms health care from “late-stage, high intensity, illness focused, tertiary, interventional health service to a much stronger value driven focus on achieving the highest levels of health” (Porter-O’Grady, 2014, p. 65). Through this act, legislation has been created that regulates the way hospitals and physicians are reimbursed, which is built on evidenced-based, quality health care outcomes that are cost effective without infringing upon patient satisfaction. At the heart of this debate is the impact on nursing care, for nursing is the largest health care professional as well as the largest component of health care costs. Any change in the health care reimbursement will greatly affect the nursing practice (Buerhaus, 2010). In order to fully understand the impact of this health care reform, one must understand that health care reform is not a new concept. Health care reform has been transforming since the 1800s.

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

Each year the number of readmissions of the heart failure patient within 30 days of discharge has grown. The Medicare division in relation with the Affordable Care Act is reducing the amount of money they are willing to pay for readmissions to the hospital. Hospitals are now more than ever looking for ways to reduce the number of readmissions to the hospital for the heart failure patient. The purpose of this paper is take a look at a program designed with to reduce the readmission rates of one hospital to reduce the number of readmission through improved education and follow up of the heart failure patient.

According to the Centers for Disease Control and Prevention (CDC) there are an estimated 5.1 million adults suffering from heart failure (2013). As the prevalence of heart failure continues to rise, one out of every nine deaths occur as a result of this chronic condition. Studies conducted at Yale found in Medicare age patients with heart failure, there is a median 30-day mortality rate of 11.1% and 5-year rate of approximately 50% (Alspach, 2014). According to Desai & Stevenson (2012), rising costs of care are in direct correlation to the number of hospital admissions related to a primary diagnosis of heart failure especially among adults age 65 years or older. The national rate for readmissions within 30 days is approximately 24.7%, consequently having

Hospital readmission rate has gained attention over the last few years because it reveals the

To contain the cost experienced by hospitals with HF readmissions, evidence based practice must be applied to avoid reduction penalties by CMS. Evidence base practice shows implementing effective outpatient measures have reduced HF readmissions by 14% to 87% (McClintock et al., 2014). These outpatient measures include case management, early follow-up care, heart failure clinics, cardiac rehabilitation, medication reconciliation regimen, mailing & telecommunications home health and targeting caregiver burden (McClintock et al., 2014). Subsequently, prior to discharge it is the responsibility of the nurse to advocate for the patient. Effective teaching and patient reinforcement of information is important to avoid readmissions of any time

Preventing CHF readmission rates is a multi-factorial approach that involves careful monitoring and patient participation. Providers can decrease CHF readmission rates through evidence-based practice and extensive patient education. The first step in preventing CHF readmission rates is recognizing those at higher risk for readmission. The studies reviewed demonstrated that certain physiological and socio-economical factors are indicators for higher risk of readmission rates. Diabetes, number of hospital visits, and the dosage of diuretics have been shown to be indicators of readmission (Cubbon et al, 2014). Lab values such as BNP and creatinine can be used to assess severity of disease and therefore risk for readmission (Feola et al, 2011). Factors such as age, race, gender, physical health, low socioeconomic status, lack of support systems, and severity of disease have shown to affect hospital readmission rates (Bos-Towen et al, 2015). Early detection for increasing severity of disease process can lead to early intervention and management. Being able to recognize indicators for readmission is the first step in a multi-step approach for managing patients with CHF.

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.

Nurses have the power to increase positive patient outcomes by implementing changes in their practice based on the evidence found in the nursing literature. Utilizing evidence-based practice (EBP) increases nurses job satisfaction, increases communication across the interdisciplinary team, enables nurses to provide their patients with high-quality care and decreases health care cost. The purpose of this paper is to describe why readmissions from nursing homes (NHs) is a nurse practice problem, nurse practice changes to reduce hospitalizations in NHs, evidence found in the nursing literature