Nursing Involvement Of Reducing Hospital Readmissions

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.

Healthcare reimbursement systems within the United States are a complex structure for obtaining payment for services rendered. The healthcare system officers are required to understand the ordinary principles of the payer system. Understanding the rules, and keeping up with the continuous changes will allow the providers, physicians, and facilities to gain an advantage in this growing healthcare domain. Both private and commercial insurance companies provide a diverse menu of choices to customers. All third-party payers create interest in decreasing healthcare costs and improve control access to the not needed services. This paper will address the complexity of the healthcare reimbursement systems in the United States. Additionally, the research

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

What factors contribute to multiple Chronic Obstructive admissions and how can the number of readmissions within 30 days be reduced? The Affordable Care Act added section 1886 to the Social Security Act. This section created the Hospital Readmission Reduction Program (HRRP). The purpose of HRRP is to reduce hospital spending and improve quality of care (Sjoding & Colin, 2014). HRRP requires Centers for Medicare and Medicaid Services (CMS) to reduce, or penalize, hospitals receiving payments from CMS for excessive admission of several chronic diseases, taking affect in October 2012 (CMS, 2018). Chronic Obstructive Pulmonary Disease was added in 2015 as one of these conditions.

Kaiser Family Foundation defines readmissions as an event where a patient is admitted to a hospital within specified time period after being discharged from an initial hospitalization, for example, in case of Medicare, this time period is set at 30 days (Boccuti & Casillas. 2015). High hospital readmission rates have been a problem for many years in US healthcare system, however in recent years intense measures and practices to reduce avoidable re-hospitalization coupled with awareness of the issue has become a high priority for all healthcare providers. According to a study conducted by Jencks, Williams & Coleman, after analyzing the Medicare claims data from 2003 - 2004, almost 20% of the patients were re-hospitalized within

As we care for our patients in a hospital settings, our goal is to get them better so that they can be discharged. Most of the time recovery continues at home or at another facility. With shorter stays in the hospital setting, the recovery at home requires increased nursing and caregiver interventions. Based on statistics published by the Center for Medicare and Medicaid Services (CMS), the rate for readmission, within the first 30 days of discharge, in 2012, for Medicare FFS (Fee-for-service) beneficiaries, averaged 18.4 percent (Gerhardt et al., 2013). Throughout this paper, readmission refers to a “return hospitalization to an acute hospital following a prior acute admission within

Due to the passing of Obamacare, also known as The Affordable Care Act, American’s today are provided more access to healthcare than ever before. The Patient Protection and Affordable Care Act (ACA) was signed into law by President Barack Obama in March 2010 and signifies universal healthcare reform. This legislation includes provision in healthcare to extend coverage to millions of uninsured Americans. The ACA reform bill contains many other important changes as well, including, implemented measures to lower healthcare costs, improve system efficiency, eliminate coverage denial for pre-existing conditions, and increase coverage for children or dependents to age 26. What effect will this new law for healthcare reform have on hospitals, individuals, nurses, other healthcare providers, and on America? Throughout this paper the author will explore the changes and how our economy, political, and healthcare delivery system is affected.

Hospital readmission is an avoidable healthcare issue. Pedersen, Meyer&Uhrenfeldt (2014) “defined hospital readmission as a return to hospital shortly after discharge from a recent stay”. When most patients leave the hospital, the intent is not for a reappearance in the hospital again soon. But, many discharged hospital inpatients get readmitted sooner than 30 days from their initial discharge. Some readmissions are projected or could be as a result of natural cause. Other patient readmissions due to lack of hospital quality care could be an avoidable readmission.

The increase in individuals acquiring health insurance, due to the Affordable Care Act, causes an increased demand for physicians and physician services (ProCon.org, 2015). As a result of these increases, hospital systems are being face with what is now their biggest challenge, financial burden. The number one financial burden is medical reimbursement. However, stemming from the burden of medical reimbursement, several other challenges are brought forth, such as operating costs and the increased costs for staff, supplies, etc (Ache.org, 2016). Leaders within the hospital setting are having to adjust certain aspects of their operating system in order to keep their hospital systems afloat.

The business goals of modern healthcare include the need to increase patient safety and satisfaction, to eliminate fraud, waste, and abuse, and to maintain employee satisfaction in order to control costs and increase profitability. However, in reviewing the history of healthcare reimbursement, this was not always the case and at a point in time existed where the cost of healthcare was escalating exponentially due to abuses in the way providers were allowed to utilize and bill for services. Due to this, the changes in how healthcare services are reimbursed changed dramatically over the past several decades with those changes designed to create savings for insurers and those entities paying health care premiums.

Hospitals and other healthcare institutions are under increasing pressures to provide medical treatment to patients with limited and reduced reimbursements from medical insurance providers. There is also a substantial increase in the number of patients without health insurance. The Emergency Medical Treatment and Active Labor Act is a national mandate that requires healthcare organizations to access and stabilize any person who seeks medical treatment regardless of their ability to pay (Kaji, Koenig, & Lewis, 2007). Public health facilities are challenged financially with complying with state and federal mandates such as required implementation of electronic medical records and the Health Insurance Portability and Accountability Act of 1996 (Hanfling, Schafer, & Armstrong, 2004).

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.

Usually CHF patients stay in the hospital is from three to ten days, or in severe cases, duration of their stay in the hospital increases. In normal conditions, nurse patient ratio is 6:1. During their stay in the hospital, patients and nurses have more frequent interactions. They usually develop cordial relationship with each other. Both share their thoughts and information with each other. If this relationship is used properly and nurses start educating their patient from the very beginning by morally supporting them.

Furthermore, collaborative communication that emphasizes shared decision making between provider and patient is associated with patient activation and medication adherence.7,8 The purpose of this research is to examine the relationships of hospital inpatients ' perceptions of nurse communication and patients’ understanding of their prescribed medications to begin to build a framework for interventions to support patients’ medication self-management.

There are many articles related to hospital readmission, but this article looked at readmissions with a different purpose. This article studied not only the reasons behind hospital readmissions but also the timing and factors connected with unplanned postoperative readmissions. Hospitals are or should be taking on the task of reducing hospital readmissions as many insurance carriers including Medicare penalize hospitals for readmissions within the first 30 days of discharge. Hospitals must first know what is triggering a readmission and address the situation and create a plan to reduce readmissions and the cost.