Health Care Readmissions: A Case Study

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

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

The Affordable Care Act was enacted to improve health care and to lower health care cost in America. The ACA developed different strategies to meet these goals called the “pay for performance” programs. These strategies are aimed at the different providers to improve quality care. The strategy that I selected is the “Hospital Readmissions Reduction Program” this program/strategy is also known as the HRRP and was begun in October of 2012. HRRP is aimed at hospitals and penalizes hospitals that have a high 30 day readmission rate. The penalties are assessed and based on a number of comparisons, those such as, performance, patient demographics, comorbidities and frailty.

Are our patient’s culture, language barrier, education level, and poverty factors leading them into early hospital readmissions?

Readmission to a hospital creates strain and added expense for the patient and hospital; in 2011, hospital costs due to readmission were almost $41.3 billion (Hines, Barrett, Jiang, & Steiner, 2014; Rau, 2014). There are many aspects of healthcare associated with readmission, such as lack of discharge planning and education, which need to be addressed i to decrease the amount of preventable re-hospitalizations.

Hospital readmission is an avoidable healthcare issue. Pedersen, Meyer&Uhrenfeldt (2014) “defined hospital readmission as a return to hospital shortly after discharge from a recent stay”. When most patients leave the hospital, the intent is not for a reappearance in the hospital again soon. But, many discharged hospital inpatients get readmitted sooner than 30 days from their initial discharge. Some readmissions are projected or could be as a result of natural cause. Other patient readmissions due to lack of hospital quality care could be an avoidable readmission.

Hospital readmission rates are thought to be a representation of poor quality and efficient care. Readmissions have become recognized as an emerging concern as they place a financial burden on the system as well as a personal burden on the patient and their family. Of patients that are discharged from hospitals, 19.4% will be readmitted within thirty days and 51.6% will be readmitted within one year (Roberts & Robinson, 2014). Reducing readmissions is very important to decrease costs for the patient and the facility, ensure hospitals are providing quality care, and decreasing the risk of the patient suffering from a secondary infection or injury. Every discipline plays a vital role in reducing readmission rates, including therapists and health

Kaiser Family Foundation defines readmissions as an event where a patient is admitted to a hospital within specified time period after being discharged from an initial hospitalization, for example, in case of Medicare, this time period is set at 30 days (Boccuti & Casillas. 2015). High hospital readmission rates have been a problem for many years in US healthcare system, however in recent years intense measures and practices to reduce avoidable re-hospitalization coupled with awareness of the issue has become a high priority for all healthcare providers. According to a study conducted by Jencks, Williams & Coleman, after analyzing the Medicare claims data from 2003 - 2004, almost 20% of the patients were re-hospitalized within

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

(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)

The single most important impetus for healthcare reform throughout recent history has been rising costs (Sultz, 2006). In the book called The healing of America: a global quest for better, cheaper, and fairer health care, Reid wrote that the nation’s health care system has become excessively expensive, ineffective, and unjust. Among the world’s developed nations, the US ranks near the bottom for healthcare access and quality. However, the US ranks at the top for health expenditure as a percentage of the Gross Domestic Product (GDP) and average of $7,400 per person (Reid, 2010). Therefore, Americans are spending

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

Health care expenditures in the United States are currently about 18 percent of GDP, and this share is expected to continue to rise with the share of GDP devoted to health care in the United States projected to reach 34 percent by 2040 (CEA, 2009). U.S. spending on healthcare is greater than any other developed country, yet unlike others which provide near universal coverage, the United States still has 46 million uninsured (Godell, 2008). For

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.

Healthcare costs in the United States have been rising for several years and show no sign of stopping. In 2008, the United States spent on 2.3 trillion on healthcare, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 19801. Although the large amount of money invested in healthcare does translate to better care for Americans, the worsening economic situation, rising costs, and federal government’s deficit have placed a great strain on the system. This includes private employer-sponsored health insurance coverage and public insurance programs such as Medicare and Medicaid. According to the Henry J. Kaiser Family Foundation, a private and non-profit healthcare analysis organization, “in 2008, U.S. health care spending was about $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP); this is among the highest of all industrialized countries”1. Concerns for the enormous strain on the financial systems that fund healthcare and the desperate need to provide adequate healthcare for Americans have driven many a President since Theodore Roosevelt in 1912, to seek some type of healthcare reform and universal healthcare for all Americans. President Barack Obama succeeded where many had failed and on March 23, 2010, a national health reform law, the Patient Protection and Affordable Care Act was signed into law. On March 31, 2011, the Department of Health and Human Services (HHS) issued new rules