Early Readmissions

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.

Decreasing the rate of hospital readmissions has been targeted as a high priority for United States healthcare reform. Proper discharge planning that utilizes an interprofessional team, while determining appropriate patients that will benefit from such models will go a long way in reducing readmissions, meeting the patients at the level of their needs, meeting a performance measure that has been saddled with discouragement by the staff, and finally opening up access to care of patients otherwise that will have ben occupied with those that did not need or could not use it.

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.

Although readmission to the hospital may occur in some cases, researchers have found that there are preventable readmissions

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

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?

CMS 30 day-readmission penalties have motivated hospital to reevaluate discharge planning in hopes to reduce 30-day readmissions. Lopes et al. (2015) used the CRUSADE registry to evaluate causes associated with 30-day readmissions. This study included 36,711 patients with non-ST segment elevation myocardial infarction, age > 65 enrolled February 15, 2003 – December 29, 2006. This study evaluated comorbidities and cumulative incidence of readmissions over one year and found that readmissions with the very elderly having 50% mortality rate at 1 year which was thought to be impacted by co-morbidities, deconditioning and avoidance of core measure post-MI medications for various reasons. The final conclusion was that

Hospital readmissions and emergency room visits are on the rise particularly for patients with low socioeconomic status, limited resources, or who live in rural areas. Post-operative infections, asthma attacks, heart failure exacerbations and other conditions that could have been prevented seem to be driving this pattern. This has caused a downstream impact on patient safety and poor patient outcomes.

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.

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 U.S government spends about 17% of GDP on healthcare industry which is enormously high as compared to any other industrialized nation. President Obama signed the comprehensive healthcare reform – Patient Protection and Affordable Care Act on March 23, 2010. The law worked on the principles of triple aim to reduce healthcare cost, improve quality and access for the U.S citizens. One of the fundamental component of Affordable Care Act that will affect the caregiving to the U.S citizens is payment cuts to the hospitals if they do not provide quality care to their patients. The reason behind these payment cuts is because Part A Medicare Trust may go bankrupt by 2017. Hence, it is necessary to bring the cost of healthcare under control along with providing quality care to the patients. In order to contain cost, ACA proposed Medicare Readmission Program. Effective October 1, 2012 Medicare will reduce payments to the hospitals that will have higher percentage than the specified amount of preventable readmission rates. Effective fiscal year 2015, Medicare will penalize the hospitals by 1 % that will show higher number of hospital acquired infections (KFF, 2013). CMS has reported that approximated one out of every 5 Medicare patients are admitted back to the hospital within 30 days of their prior inpatient stay. Readmission rates are generally high for hospital that serve more vulnerable population like safety net hospitals. The high readmissions are caused by a

Edgar Allan Poe is known as the master of horror and gothic writing. In a sense, he has taken the meaning of the word “horror” and turned it into an entirely different definition, even a different world. Poe's narrators do not make the reader scared, per se, but they make him or her inquire about things around them. Although people should never assume, they should always speculate and investigate. In “The Fall of the House of Usher,” Poe uses an imperfectly informed narrator because he wanted the reader to play with – and question – reality, to use their senses and imagination, and be able to tell the difference between dreams and reality.

In the Public Field, we are constantly applying theories in order to better understand how the public works and to better assist the communities in different aspects of health. According to Glanz, Rimer, and Viswanath (2008), theories in which focus on beliefs and actions of individuals are the first theories of health behavior that are still being practiced around the world today. The individual theories either known as intrapersonal theories that are still being used today are the following: Health Belief Model (HBM), Theory of Planned Behavior (TPB), Transtheoretical Model (TTM), and the Precaution Adoption Process Model (PAPM) (Glanz, Rimer, & Viswanath, 2008). Each one of these individual theories can be applied to different scenarios

Multidisciplinary teams must be used to ensure that transition of care measures are completed. Some patient factors that are predictors of readmission due to rebleeding are features of shock at presentation; melena; age > 60 years; associated comorbidities like heart, liver or renal failure; larger ulcer size; stigmata of recent hemorrhage on endoscopy(11). Some factors in care that are predictors of readmission include early discharge within 72 hours for high risk patients, inadequate PPI dosage, insufficient discharge

Every year, the folks behind the podium look for new trends and ideas to wow their audience to a possible extent, by delivering uniquely engaging and impactful presentations. And therefore, we have done all the legwork to bring you a summation of the trends forecasted by the presentation and design veterans for the year 2016.