Reducing Readmission For Patients Over 65 Years Of Age

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 (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

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.

Hospitals nationwide have been striving to reduce the rate of patient readmissions. Both the federal government and private insurers are tired of picking up the tab. In a 2009 study in the New England Journal of Medicine, researchers estimated that a year's worth of unplanned re-hospitalizations cost Medicare alone $17.4 billion. Congestive heart failure is a particularly big target, as one in four patients end up back in the hospital within 30 days of discharge. Starting in the fall of 2012, the government will cut Medicare reimbursements for hospitals with higher-than-expected 30-day readmission rates for heart failure and two other conditions: heart attack and pneumonia (Avril, 2011).

emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the effectiveness of a 24-week exercise and telephone follow-up program. Journal Of The American Geriatrics Society, 57(3), 395-402. doi:http://dx.doi.org/10.1111/j.1532-5415.2009.02138.x

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

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)

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

In December 2015, The Joint Commission launched a campaign seeking to reduce readmissions by providing resources for both health care providers and patients to engage patients in the discharge planning process.1,2 According to voluntarily reported data collected by The Joint Commission between January 2014 and October 2015, the major contributors to 197 sentinel events were failures in patient communication, patient education, and patient rights.2 A review of communication during the hospital discharge process found that discharge summaries often lacked information on counseling, treatments, discharge medications, test results, and follow-up plans.3

High readmission rates of patients present challenges within the healthcare industry. Nearly one third of the United States health expenditures are associated with preventable readmissions and an estimated 20% of patient readmissions occur within 30-days (Cloonan, Wood, & Riley, 2013). As costs and penalties associated with high readmission are expected to increase, the development and

Hospital readmission rate has gained attention over the last few years because it reveals the

The researchers used a single-center randomized controlled trial whereby they compared the outcomes of usual care vs. transitional care. TC patients received a pre-discharge visit, two home visits, and intermittent telephone calls over a 9 month period. TC program focused on promoting self-care education and support, optimized condition surveillance, and facilitation of community services. The results of the study found that TC participants experienced lower mortality and hospital readmission rates compared to patients who received usual care. However, researchers noted that the difference between readmission rates steadily diminished as a patient was father and farther removed from the initial post-discharge period. Other important findings were that program participants were found to have a shorter overall length of stay and demonstrated greater self-care knowledge and improved quality-of-life compared to their counterparts. Although the effect of transitional care programs on readmission rates seemed to attenuate over time, these programs continue to show promise at improving outcomes of care for HF patients.

Not only is CHF one of the most common reasons for hospitalization in the over 65 population, but from 2000 to 2010 CHF was the reason for over 1 million hospital admissions each year (CDC, 2016). UpToDate states that about 25% of those hospitalized for CHF are readmitted within 30 days of discharge, and 30% are readmitted from 60 to 90 days (Horwitz & Krumholz, 2016). Not only does a hospitalization from CHF affect the individual’s life, but it has a great financial burden on the U.S. health system, costing nearly $30.7 billion every year (CDC, 2016). It is estimated that readmissions account for over $2 billion alone (Centrella-Nigro,

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.