The Role Of The Nurse Leader

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.

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

Why is this important? The Affordable Care Act established the Hospital Readmission Reduction Program requiring the Centers for Medicare and Medicaid Services to withhold to cut decrease payment to hospitals with a high readmission rate (White et.al, 2014). The cost of poor transitions from hospital to outpatient care costs over $12 billion yearly (Dreyer, 2014). Financial penalties are incurred by hospitals when there is a readmission in less than 30 days hence the need to identify and address the reasons for readmission. One in five Medicare patients will be readmitted in less than 30 days

It may seem inevitable that high readmission rate is one of the challenges that an acute care setting is currently facing. According to studies, 20 percent of Medicare patients alone, get readmitted within 30 days of discharge. (Alper, E., O’Malley, T., & Grrenwald, J. 2017). Avoiding or preventing hospital readmission within 30 days of discharge can help Medicare save around $17 billion dollars yearly. (Morse, S. 2016). Understanding and getting to the root of why high re-admission rates still occur is highly important. Not only it will be cost effective but will also create a better well-being on the patients.

An article by Fox and Felkey suggests four main elements, which can contribute in reduction of readmission rates (Fox & Felkey, 2013). The first category would be from improved communications between providers and patients. Second category would be educational component. Regardless of which methods get used in communicating, it would be the most helpful if it was an active two-way process involving both clinicians and patients. Increased interaction between physicians and patients can help practitioners assess patients’ condition better and hence determine patients’ need for

The number of readmissions and emergency visits have been seen to decrease when health information exchange is implemented (Yeaman & Rodolfo, 2015). This is really good news for hospitals therefore, they need to embrace the technology. Furthermore,  the Centers for Medicare and Medicaid Services (CMS) is really focusing on the quality of care being delivered by acute care facilities. The hospitals with soaring number of readmissions within 30 days of discharging patients will receive very stiff penalties from CMS under the new rules (Yeaman & Rodolfo, 2015).

The finding suggests outpatient monitoring can effectively reduce 30 day readmission rate. There are not enough evidence to just one intervention as a gold standard over others. When it come choosing the intervention to implement, it even get harder due to contradicting results by the studies. If resources allow, the best option is the use of more than one intervention to reduce 30 day readmission.

This report set provides metrics on utilization of care performed across the organization for Emergency Departments, and enables trending of ED utilization and cost over time to uncover addressable insights. It is normalized per 1000 beneficiaries.

Hospital Readmission has a high trouble to healthcare systems and patients. Most readmissions are thought to be connected to quality of healthcare system. Hospital readmissions are used for several purposes, such as cost control or as correcting measure for length of hospital stay or other outcome

In the past decade, new advancements in medicine and new methods of delivering healthcare have initiated an important conversation: what can healthcare professionals do to reduce the amount of times that a person with a chronic disease visits the emergency department? A novel solution to an issue that was costing the healthcare system millions was the introduction of the transitional care model. According to Transitional Care (Naylor & Keating, 2008) transitional care is an eclectic range of services that helps bridge the gap between the hospital, recently discharged patients and the community. Naylor and Keating (2008) analyze the major components of transitional care which range from understanding language and health literacy barriers to acknowledging the important role of family caregivers. Additionally, the services based within the patient’s community that connect them with services that can aid them in managing their chronic disease is another key component in transitional care.

Health Care systems around the world are undergoing changes. One major area of change for the United States is Emergency readmissions within 30 days of discharge form hospitals. This indicator looks at the overall percentage of inpatient admissions of patients who returned to a hospital as an emergency visit within 30 days of the leaving the hospital stay. This indicator measures rate of success of the organization in helping patient recover effectively from injuries or illnesses. If the organization does not meet the standards for readmission set forth by Medicare they will face with readmissions penalties. Readmission penalties are a reduction of payment for inpatient services for Medicare patients.

When this client-centered approach is used, it promotes patient confidence in medical personnel and ensures that when the patient leaves the Emergency department (ED) they have a firm understanding of their follow up care and plan. This makes the patient more likely to be compliant with follow up care, and self-management of their chronic issues. (Cheryle Moss, 2014)

Hospitalizations can be stressful, and even more so when they result in subsequent readmissions to the hospital. The Centers for Medicare and Medicaid Services (CMS) (2016) defines hospital readmissions as a patient admission to any acute care setting within 30-days from being discharged. Readmissions are not only a clinical issue with regards to quality, they are also a financial concern. To help identify a common diagnosis, target group, and location affiliated with hospital readmissions, our team conducted research on patient population with relatively high readmission rates. During this research, we discovered that in 2011, the United States had 3.3 million hospital readmissions, amounting to $41.3 billion in hospital costs (Advisory