Reducing Readmissions For Geriatric Heart Failure Patients

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

In the UK, reports show that heart failure has been affecting up to 2% of the population, over 900,000 people are living with heart failure, with 63,000 new cases being diagnosed each year (BHF, 2015). It costs the NHS £625 million per year, as a result of the high portion of emergency admissions, readmission and long length of inpatient stay (NHS Improvement, 2010). DH (2000) confirmed that Heart failure accounts for all cardiac admissions and the readmission rate can be as high as 50% within 3 months; also, it further estimated 50% readmission might be preventable. Unfortunately, Heart Failure can’t be cured, but early

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

Congestive heart failure is a growing chronic condition in the United States that accounts for over one million hospitalizations and is responsible for 27% of patients with heart failure on Medicare are readmitted with 30 days of discharge (Hines, Yu & Randall, 2010). The intensity of the disease process poses a financial strain on both the patient and the payers, especially Medicare, as 10 per 1000 population are 65 years or older and therefore a Medicare beneficiary (Mozaffarian et al., 2015). Consequently, in order to gain control over this chronic disease and its cost burden, the government and policy makers have shifted the responsibility to the health care facilities through the creation of policies that affect hospital reimbursement based on readmission rates. As a member of the quality team at my facility, the Hospital Readmissions Reduction Program deeply impacts my practice and encourages the hospital as a whole to focus on improving multidisciplinary collaboration in pursuit of quality patient care, resulting in better outcomes and decreased readmissions.

This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many

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

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.

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

(Horwitz et al.,2011). It is important to consider an all-condition 30-day readmission rate as a quality measure which is the standard benchmark used by the Centers for Medicare & Medicaid Services (CMS) (Horwitz et al., 2011). Rates at the 80th percentile or lower are considered optimal by CMS. Patients transferred to another hospital for longer term care will not count as a readmission. A hospital's readmission rate is calculated by dividing the total number of patients readmitted within seven days of discharge by the total number of hospital discharges” (Mayo Foundation for Medical Education and Research 1998-2014)

One of the leading concerns affecting the health care system is the high rates of unplanned hospital readmissions. While some readmissions are an appropriate part of treatment, many patients are admitted back into the hospitals due to avoidable factors that compromised their health. This critical issue, according to the Dartmouth Atlas Project, has now become a measure of the quality of hospital care. As a result, the Center for Medicaid and Medicare Services (CMS) currently penalizes hospitals with high rates of 30-day readmissions for certain conditions (PerryUndem Research & Communications, 2013). Aside from the governmental costs, those most affected are the patients, families, and their providers. Effective programs assessing the discharge plan and care coordination must be enforced to diminish the number of hospital readmissions and potential health complications.

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.

currently work on an Interventional Cardiac floor and most of our patients are repeat patients. One of the largest readmission diagnosis is Congestive Heart Failure. In 2009, their were over 750,000 patients admitted for CHF, making it the top 5th reason for admission to the hospital (AARP, 2012, para 3). CHF is al the most common readmission to the hospital (Medscape, 2010, para. 2). This is a topic that has been evaluated many times and is currently one of our Core Measures. Our institution has a very specific protocol for this kind of admission and discharge. Even with this stringent protocol set up for doctors and nurses to adhere too it is still left with the patient to comply after discharge. in my experience, noncompliance has been a

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

In an effort to curb these costs, in 2013 the Center for Medicare and Medicaid Services (CMS) enacted the Hospital Readmissions Reduction Program. Under this program, hospitals are penalized for readmissions occurring in the first 30 days. The penalties apply to specific conditions for CMS recipients including acute myocardial infarction, heart failure, coronary artery bypass graft