Prevention of Hospital Readmissions Related to Symptoms of Congestive Heart Failure

"Reducing 30-Day Readmissions for African Americans with Congestive Heart Failure by improving health literacy through a Comprehensive Context Oriented Discharge Plan”

Heart Failure affects nearly 5.8 million people in the United States. The American Heart Association reports that the total economic cost of heart disease and stroke in 2011 was $320.1 billion. ("Efforts to Prevent Heart," 2015). More Medicare dollars are spent for the diagnosis and treatment of heart failure than for any other diagnosis (Schneider, O'Donnell, & Dean, 2011). Hospital admissions for heart failure are very common, especially among Medicare aged patients, and heart failure hospital readmissions are a major contributor to rising healthcare costs. Evidence suggests that factors influencing readmission rates for heart failure patients include knowledge deficits in nursing education, standardized patient education, and transitional

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.

The Affordable Care Act (ACA) added to the Social Security Act has increased the financial accountability of healthcare organizations for preventable readmissions. Hospitals have increased their awareness and are looking for system ways to assist in the reduction. The Centers for Medicare and Medicaid Services (CMS) have initiated a process for decreasing the reimbursement for readmitted patients within a 30-day period. CMS identified readmission measures for applicable conditions of acute myocardial infarction (AMI), heart failure (HF), pneumonia and in 2015 chronic obstructive pulmonary disease (COPD) and hip and knee replacement which are included within the measurement to calculate the readmission payment adjustment for

The Hospital Readmissions Reduction Program (HRRP) was passed in 2012 under the Affordable Care Act, to help hospitals to improve patient care and reduce costs. (Danner, 2016). The diagnoses with the highest readmissions rates associated with the highest expense are: acute myocardial infarction (AMI), pneumonia, and congestive heart failure. CMS also extended their program in 2015 to incorporate reimbursement reduction for hip/knee replacements, Chronic Obstructive Pulmonary Disease (COPD), and they also have plans in 2017 to include the

This paper deals with the legislative, regulatory components of Medicare Readmission Reduction Program along with recommendation to reduce their readmission rates for a health care facility like Valley hospital in Spokane which has been penalized a higher percentage of 2% as compared to other hospitals in the state of Washington under the third round of penalties.

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.

The difference between a successful discharge and an avoidable readmission comes down many times to poor care coordination on

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.

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

Risk Factors: Before changes can be made to reduce readmission, an evaluation needs to be made to what is contributing to readmissions. In 2012, an average monthly readmission was 44 patients for every 1,000 FFS beneficiaries discharged (Gerhardt et al., 2013). Besides disease process, one of the risk factors, mentioned in the articles were lower cognitive functioning. Depression, which is common later in life, can effect cognitive functioning. To measure depression, the use of the Geriatric Depression Scale (GDS) has been tested to be a reliable tool (Greenberg, 2007). Poor clinical status, older age and poor health behaviors are also factors (Tao & Ellenbecker, 2013). Lower functional ability has be shown to contribute to increase risk for readmission. Functional ability can be measured by the scoring criteria in the Lawton Instrumental Activates of Daily Living Scale and the Katz Index of Independence in Activities of Daily Living (Graf, 2008a; Tao & Ellenbecker, 2013; Wallace & Shelkey, 2007). Communication breakdown and the lack of continuity between the hospital setting and the home setting also contributes to poorer patient outcome (Berry et al., 2011).

This intervention would be cost effective for the six hospitals involved. It is estimated that billions of dollars are spent yearly by Medicare on repeat hospital encounters(cite). The Center for Medicare and Medicaid (CMS) penalizes hospitals for readmissions within 30 days of the initial encounter. It is in the best interest of the hospital to implement programs and interventions that will help to mitigate the revolving door of repeat encounters. As a result of the potential loss in revenue from CMS the 6 hospitals are looking for interventions that will aid them in avoiding repeat encounter. This will ensure they will receive the

My vision for this practicum project stemmed from recent reports of soaring readmission rates for Vanguard Hospital core measure patients; which include patients with a diagnosis of a myocardial infarction, congestive heart failure, and pneumonia. Preventing unnecessary readmissions for core measure patients was the topic of discussion at the monthly staff meeting that I attended. The Director of Nursing and Quality Improvement Coordinator led the discussion; which included, informing the staff of recent Medicare and Medicaid reimbursement cuts related to the increase in readmissions for these particular patients. In addition, statistical information was displayed using SHP data and the Midas Report, revealing how Vanguard Hospital and Home

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.

Diagnosed with Congestive cardiomyopathy implies that the patient’s heart muscle has been debilitated by ailment and cannot sufficiently pump blood through the heart, which can lead to heart failure (“Columbia University Medical Center”, 2016). In this case study, the current situation of a male patient Mr. P., who is 76 years old, and frequently hospitalized with CHF is given. The purpose of this paper is to describe an approach to care with treatment plan recommendation, provide education to both the patient and his family, and a teaching plan.