Healthcare Program Policy Evaluation Analysis
Healthcare Program/Policy Evaluation Analysis Template
Use this document to complete the Module 6 Assessment Global Healthcare Comparison Matrix and Narrative Statement
| Healthcare Program/Policy Evaluation |
Hospital Readmission Reduction Program (HRRP |
| Description | The HRRP program was introduced by the Centers for Medicare and Medicaid Services to reduce the number of preventable patient hospitalizations. According to the program, healthcare facilities that exceed the expected 30-day readmission rates incur financial penalties in the form of reduced payouts. Readmissions are defined as repeat hospitalizations in a period of 30 days among CMS-involved facilities. The program exempts specific medical conditions, including heart failure, multiple morbidities, and pneumonia (Wadhera et al., 2019). |
| How was the success of the program or policy measured? | The success of the program was measured based on the number of readmissions in CMS-involved healthcare facilities. 30-day readmission rate is considered a reliable measure of the quality of patient care, with high readmission rates linked to low quality of care. |
| How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? | The HRRP program directly affected all healthcare facilities involved in CMS, and approximately 57 million people 65 years old and above are beneficiaries of Medicare (Gupta & Fonarow, 2018).
The HRRP penalties began in 2012 for higher-than-average readmissions for acute myocardial infarction, heart failure, and pneumonia. The total financial penalties on CMS Medicare reimbursement gradually increased from an initial 1% in 2012 to 3% subsequently (Fonarow et al., 2017). The program resulted in a significant reduction in the readmission rates in affected healthcare facilities. The all-cause readmission rates among beneficiaries of the Medicare fee-for-service plan in CMS-affiliated facilities reduced from 19.5% in 2011 to 18.5% and 17.5% in 2012 and 2013, respectively. This represented a reduction in readmissions of approximately 150,000 between 2012 and 2013 (Department of Health and Human Services, 2014). Specifically, the rate of readmissions for heart failure reduced by 9% (Gupta & Fonarow, 2018). |
| What data was used to conduct the program or policy evaluation?
|
The program was conducted based on the risk-standardized 30-day readmission rates (RSRR) as an indicator of healthcare quality in healthcare facilities that are involved in the CMS program. This data was collected by CMS and used to determine financial penalties for facilities whose data exceeded the stipulated metrics (Fonarow et al., 2017). |
| What specific information on unintended consequences was identified?
|
One unintended consequence of HRRP was an increase in mortality from specific health conditions, including heart failure. The program significantly increased 30-day, 90-day, and 12-month mortality due to heart failure among Medicare beneficiaries.
Additionally, safety-net healthcare facilities that care for socio-economically disadvantaged and vulnerable populations were more affected by the HRRP penalties, potentially contributing to worsening health disparities (Gupta & Fonarow, 2018). |
| What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
|
Several stakeholders were identified in the evaluation of the HRPP, including the U.S Department of Health and Human Services (HHS) through the CMS agency, CMS-affiliated healthcare facilities, CMS-involved safety-net healthcare facilities, Medicare fee-for-service beneficiaries, specifically those with established medical conditions such as heart failure and vulnerable socio-economic minority populations (Gupta & Fonarow, 2018).
Evaluation of the HRRP will enable the HHS to understand the effectiveness of the program in reducing readmission rates and healthcare spending and provide data on unintended consequences to guide policy improvements. For example, additional exemption measures may be required to protect safety-net facilities and their population base from the negative health impacts of financial penalties. On the other hand, the evaluation provides factual and statistical data on the unfavorable consequences for CMS-involved healthcare facilities and Medicare beneficiaries to lobby for policy revisions. |
| Did the program or policy meet the original intent and objectives? Why or why not? | The HRPP program met its original objectives. The original objective of the HRRP was to reduce healthcare spending. Accordingly, Medicare spending on readmissions was reduced by more than $2.2 billion between 2010 and 2016 (Khera & Krumholz, 2018). Therefore, the program achieved its original objective by yielding significant cost savings. |
| Would you recommend implementing this program or policy in your place of work? Why or why not? |
Since the HRRP was effective in reducing readmission rates and healthcare spending, I would recommend it for my place of work as a strategy for minimizing costs. However, I would consider additional adaptive measures by introducing additional provisions to protect vulnerable stakeholders, such as patients with a significant risk of morbidity and mortality from being affected negatively. |
| Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation. | As a nurse advocate, I can contribute to program evaluation efforts by providing accurate feedback and effectively reporting incidences in the clinical setting to provide data on a program’s intended and unintended consequences.
Secondly, I can contribute to program evaluation by conducting literature studies and reviews in order to gather and communicate the evidence related to a health program to relevant stakeholders. |
| General Notes/Comments | The HRRP is an effective healthcare program that improves the quality of healthcare and minimizes healthcare costs. However, the program can potentially worsen health inequalities, necessitating the need for additional improvements. |
References
Department of Health and Human Services. New HHS data shows major strides made in patient safety, leading to improved care and savings [Internet]. Washington (DC: HHS; 2014 May 7 [cited 2015 Dec 3 ]. Available from: http://innovation.cms.gov/Files/reports/patient-safety-results.pdf
Fonarow, G. C., Konstam, M. A., & Yancy, C. W. (2017). The hospital readmission reduction program is associated with fewer readmissions and more deaths: time to reconsider.
Gupta, A., & Fonarow, G. C. (2018). The Hospital Readmissions Reduction Program—learning from the failure of a healthcare policy. European journal of heart failure, 20(8), 1169-1174.
Khera, R., & Krumholz, H. M. (2018). Effects of the Hospital Readmissions Reduction Program: The MedPAC Report.
Wadhera, R. K., Yeh, R. W., & Maddox, K. E. J. (2019). The hospital readmissions reduction program—Time for a reboot. The New England journal of medicine, 380(24), 2289.
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Question 
Healthcare Program Policy Evaluation Analysis
Assignment: Assessing a Healthcare Program/Policy Evaluation
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role in assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
To Prepare:
- Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
- Select an existing healthcare program or policy evaluation, or choose one of interest to you.
Healthcare Program Policy Evaluation Analysis
- Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
- Describe the healthcare program or policy outcomes.
- How was the success of the program or policy measured?
- How many people were reached by the program or policy selected?
- How much of an impact was realized with the program or policy selected?
- At what point in program implementation was the program or policy evaluation conducted?
- What data was used to conduct the program or policy evaluation?
- What specific information on unintended consequences was identified?
- What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
- Did the program or policy meet the original intent and objectives? Why or why not?
- Would you recommend implementing this program or policy in your place of work? Why or why
not? - Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a
program or policy after 1 year of implementation.