Centers for Medicare and Medicaid Services

Centers for Medicare and Medicaid Services

According to Catalyst (2018), the Hospital Readmissions Reduction Program adopted by Medicare is a value-based acquisition program. It focuses on improving the quality of care provided by hospitals through the advocacy of optimized communication and better coordination of patient care (Catalyst, 2018). Open communication is important when presenting discharge plans to patients. It can enhance compliance, improve the patient’s prognosis and minimize unnecessary readmissions.

The Centers for Medicare and Medicaid Services (CMS) provides incentives to hospitals to minimize readmissions for patients aged 65 years and above (Lu et al., 2021). The CMS focuses on six diagnoses and procedures for thirty days to identify avoidable readmissions (Lu et al., 2021). According to Lu et al. (2021), these diagnoses include heart failure, acute myocardial infarction, pneumonia, coronary artery bypass graft surgery, chronic obstructive pulmonary disease, and elective primary total hip arthroplasty or total knee arthroplasty.

Studies reveal that the Hospital Readmissions Reduction Program has improved the quality of healthcare services discharged to patients. Statistical data demonstrate reductions in readmission rates for acute myocardial infarction, pneumonia, and heart failure (Gai & Pachamanova, 2019). This is an indicator of better coordination of healthcare services and communication between healthcare providers and patients. This is beneficial for vulnerable populations and society because their quality of life is increased.

Hospitals that receive higher-than-expected readmissions are penalized and hence receive lower reimbursements from Medicare. These cover all Medicare fees for service procedures and diagnoses in a specific financial year. The CMS has set its penalty at 3% (Catalyst, 2018). Hospitals receive annual feedback from CMS and are allowed to raise complaints of miscalculations within 30 days.

Various strategies can be adopted to reduce hospital readmissions. Patients’ needs assessment identifies those who are at a higher risk for readmission and ensures that they understand discharge plans (Warchol et al., 2019). Medication reconciliation helps to avert possible adverse drug events that necessitate readmissions. The other strategies include patient education, timely follow-ups, prevention of nosocomial diseases, and optimized communication (Warchol et al., 2019).

References

Catalyst, N. E. J. M. (2018). Hospital Readmissions Reduction Program (HRRP). NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/cat.18.0194

Gai, Y., & Pachamanova, D. (2019). Impact of the Medicare Hospital Readmissions Reduction Program on Vulnerable Populations. BMC Health Services Research, 19(1), 1–15. https://doi.org/10.1186/s12913-019-4645-5

Lu, C. H., Clark, C. M., Tober, R., Allen, M., Gibson, W., Bednarczyk, E. M., Daly, C. J., & Jacobs, D. M. (2021). Readmissions and Costs Among Younger and Older Adults for Targeted Conditions During the Enactment of the Hospital Readmission Reduction Program. BMC Health Services Research, 21(1), 1–17. https://doi.org/10.1186/s12913-021-06399-z

Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to Reduce Hospital Readmission Rates in a Non-Medicaid-Expansion State. Perspectives in Health Information Management, 16(Summer), 1–20.

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As we have learned this week from our lectures and required textbook reading, leaders and managers in healthcare must work diligently and continuously to assess the health and needs of the populations they serve. Total quality management (TQM) is a process that is used to analyze the available relevant data, plan for improvements where necessary, implement plans, and monitor the plans for effectiveness through formal processes adopted.

After thorough research of credible sources from the South University Library and the Internet, please answer the following questions:

Why do the Centers for Medicare & Medicaid Services (CMS) believe that prevention of inpatient admissions will improve the quality of care in populations served by hospitals?
What specific age group and diagnoses does the CMS monitor for readmissions?
Does research tell us that so far, prevention of readmissions has improved the quality of care for patients?
How has hospital reimbursement been affected by the readmission standard mandated by the CMS?
What recommendations (best practices) to decrease hospital readmissions have been suggested by experts in the healthcare field?
To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.