Early Readmissions

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 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

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.

Quantitatively this issue can be documented in readmission rate statistics alongside the morbidity and mortality rate among the readmission cohort. By identifying the number of patients with preventable readmissions, and then categorizing the increased incidence of infection and/or injury in this cohort compared to like populations without avoidable readmissions one could show the burden of readmission.

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

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

With a variety of trends that account for the increasing cases of the elderly population at risk for hospital readmission, the authors discuss an in depth evaluation on why this occurs. Hospital readmission, a growing health concern, tallied in a whopping $17 B in Medicare cost for unplanned hospitalizations. Readmission, refers to a return to the hospital after discharge from a recent stay where rates are reported mostly at 30, 60, and 90-day intervals after discharge. Even though the elderly, aged 60 years or older, unfailingly represent the highest rate of hospital readmissions compared to other age groups, according to the authors, readmission rates have been associated with patient demographics, chronic conditions and utilization factors. Additionally, although the aforementioned factors contribute to readmission, adverse events such as injuries that result from hospitalization or at home like medication errors. According to (Robinson, Howie-Esquivel, & Vlahov)

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

For Medicare, readmissions are defined as an admission to an acute care hospital within 30 days of discharge from an acute care hospital (Horwitz, L. et al, 2011). Factors affecting unplanned readmissions vary greatly among providers and geographical region, and are opportunities increase quality and coordination of care, thus improving health outcomes. In 2005, the Medicare Payment Advisory Commission (MedPAC) conducted the Medicare Claim Finding analysis; MedPAC surveyed hospital Medicaid claims to analyze their hospital readmission data. This research from MedPAC showed that 75% of Medicare admissions were preventable and 17.6% of Medicare admissions resulted with a readmission within 30 days (MedPAC, 2011). Furthermore, this large percentage of preventable admissions were taking a toll on payers financially. The cost of these 75% preventable readmissions amounted to fifteen billion dollars (MedPAC, 2011). This data raises concern regarding the financial burden of unnecessary admissions as well as quality issues. Due to the high cost and decreased quality of hospital

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

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.

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.

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