Prevention Of Hospital Readmissions And Post Hospital Care Programs Essay

Readmission to a hospital creates strain and added expense for the patient and hospital; in 2011, hospital costs due to readmission were almost $41.3 billion (Hines, Barrett, Jiang, & Steiner, 2014; Rau, 2014). There are many aspects of healthcare associated with readmission, such as lack of discharge planning and education, which need to be addressed i to decrease the amount of preventable re-hospitalizations.

Hospital readmissions are potentially harmful, costly and often times an avoidable event. Between the provisions set forth under the Affordable Care Act and the penalties authorized by the Centers of Medicare and Medicaid Services, hospitals are forced to shift their focus towards the development of strategies to reduce and prevent avoidable hospital readmissions related to heart failure. It is estimated that of the 6 million individuals within the United States diagnosed with heart failure, 1 million of them are hospitalized each year with a primary diagnosis of heart failure, accounting for $17 billion dollars of Medicare expenditures (Sales et al, 2013). What is worse is the death rate associated with heart failure each year, accounting

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.

In my current position, the Hospital Readmission Reduction program plays a pivotal role in my job. I am a part of a new initiative in conjunction with NexusMontgomery. “This program aims to provide care management intervention that will reduce overall hospital costs and reduce hospital admissions and readmissions in Montgomery county Maryland” (Regional Trans, 2015, p. 1). Funding is provided from The Center for Medicare and Medicaid Services. The program aims to significantly reduce the number of residents in Montgomery County with hospital admissions and readmissions. The targeted population are seniors 65 years and older. The client must have Medicare and reside in an eligible Montgomery county zip code. The program will reduce hospital

The Center for Medicare and Medicaid Services (CMS) have proposed policies that will penalize healthcare organizations for the increasing readmission rate related to patients who has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). This readmission policy is part of the CMS Hospital Readmission Reduction Program (HRRP) which was enacted to further address the diminishing quality of health care services and to curb the rising cost of health care services by providing financial incentives to healthcare organization in order to promote gravitation toward Accountable Care Organizations (ACO) or Managed Care Organization (MCO). The main objective of levying reimbursement penalties on healthcare organizations is to move away from the fee-for-service method of reimbursement toward a patient-centric, and disease management approach where healthcare services are coordinated not just in the acute phase of disease, but also in the chronic of phase disease.

Readmission is defined as “an admission to subsection hospital within 30 days of a discharge from the same or another subsection hospital” for the same diagnosis or for a complication related to the initial diagnosis (American College of Emergency Physicians, 2015). According to the Robert Wood Johnson Foundation (2014) report, the annual cost of hospital readmission in the nation is about $41 billion. More importantly, hospital readmission disrupts patient’s life and decreases the quality of life (Padhukasahasram, Reddy, Li, & Lanfear, 2015). Consequently, due to the human and economic burden of hospital readmission, the Center for Medicare and Medicaid (CMS), in 2012 implemented penalty on hospitals that exhibit a high readmission for diagnoses of Heart Failure, Pneumonia and Septicemia. This action has resulted in the reduction of readmissions to hospitals specifically associated with

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.

Interventions to Reduce Acute Care Transfers is a quality improvement program that has been used throughout health care settings worldwide. Its main goals are to decrease hospitalizations and readmissions, with an overall aim of improving quality of care (Ouslander et al., 2014). Interact’s website provides health care facilities with affordable and easy to use “tool kits” that are based on five fundamental strategies including; principles of quality improvement, early identification and evaluation of changes in condition, management of common changes in condition, improved advance care planning, and improved communication and documentation (Ouslander et al., 2014). By using the tools health care providers can help prevent unnecessary hospitalizations and related complications, at the same time receive financial

In a quarter of the hospitals, about 25% of the admissions are rehospitalizations that occur within 30 days after discharge (Jencks). There are a number of factors that contribute to avoidable hospital readmissions. Some of these reasons include: poor quality and transition of care between different providers and care setting, discharging of patients prematurely, discharging patient without providing adequate information of their care and the lack of coordination with information of patients between inpatient and community-based providers.

Across the U.S., many Medicare beneficiaries rely on hospitals servicing low-income areas for their care, placing additional financial pressure upon the institution. It is reported that each year within the U.S. one of five Medicare recipients returns to the hospital within 30 days of discharge, roughly costing the program $18 billion (Mittler et al., 2013). Many of these readmissions are for conditions that are thought be preventable had patients received the proper discharge planning, education, and support. Upon survey,

One such study designed a tool for discharge to assist providers in making sure that patients received all appropriate information regarding methods to care for themselves prior to being discharged to another level of care or to home. Hence, the AHRQ along with Boston University Medical Center, prepared the Reengineered Discharge (RED). As per the patients’ needs for safe and effective discharge the RED tool was designed to provide the provider with a clear and concise method to discharge all patients. The RED process is an evidence-based intervention that has been implemented in over 300 hospitals in the U.S. and found to decrease hospital readmissions by 30% (Joint Commission Resources, 2016). While the program has been noted to be significantly effective, the implementation to be done correctly and effectively may take from 6-12 months or longer (Agency for Healthcare and Administration, 2013). Although it appears an extensive period, the goal is designed to improve the care coordination that is offered to patients at any specific site. The RED tool provides organizations information on how to align with the AHRQ practices and to encourage communication amongst providers to better assess the best plan for patients and promote follow through for each level of care. One barrier that can affect the proper and successful

The article discusses patients who are at high risk for readmission because they have complex illnesses that are severe compared to others, and the socioeconomic status of patients causing them to not follow those post discharge instructions therefore leading them to be readmitted and causing penalties for the hospitals. There were two developments for improvement which included a report from the Medicare Payment Advisory Commission indicating a small decrease in readmission, and second development included data on who will be penalized. The article argues that these two developments should be taken into consideration when measuring readmission rates and should consider making adjustments. Also the HRRP’s penalty should take low mortality rates

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.

The purpose of the daily report is to help providers, case managers and external providers to brainstorm and help prevent patients from coming back in the hospital and provide quality care. Seventy to eighty percent of the patients at HFWBH are Medicare because of its geographical location. The organization is surrounded by skilled nursing facilities (SNF), nursing homes, and assisted living, resulting in HFWBH having more Medicare patients that are admitted, and/or readmissions. West Bloomfield community population has 59 percent between 18 and 64 years old. 6.5 percent are diabled and 6 percent are below the poverty line. 17 percent of the population of the Township is 65 years and older, and 31 percent are disabled and 4 percent live below the poverty line (wbtwnsip.org, 2016). See figure 9

At the first point of contact with patients in hospital, we should start discharge planning with the full involvement of their carers, and that patients themselves should be fully and promptly involved in their own discharge plans and goals. The multidisciplinary team should work together to ensure safe discharge into the community to reduce the likelihood of further emergency admissions. By planning discharge on admission, it reflects the good embedded practice and standardised care. (Department of Health 2010). In this case a plan was made for discharge by the admitting nurse.