Preview

How To Reduce Hospital Readmissions

Satisfactory Essays
Open Document
Open Document
132 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
How To Reduce Hospital Readmissions
Joynt and Jha authors of the article “A Path Forward on Medicare Readmissions” have analyzed the Hospital Readmission Reduction Program (HRRP) implemented by the Centers for Medicare and Medicaid Services (CMS) to reduce the number of hospital readmissions for Medicare patients. CMS penalizes hospitals for high readmission rates based the calculation of expected number of readmissions for acute myocardial infarction, congestive heart failure, and pneumonia from 2008 to 2011 while adjusting age, sex, and pre-existing chronic conditions. The penalty percentage of reimbursement for Medicare patients has increased over the years to reach 3%. The penalty has been controversial with criticism focused on two main points; the first point is whether

You May Also Find These Documents Helpful

  • Good Essays

    The financial impact of the MS-DRGs for Medicare inpatients services is that the hospital can…

    • 593 Words
    • 3 Pages
    Good Essays
  • Better Essays

    This paper will describe the Long Term Acute Care Hospital (LTACH) which is affiliated with Carson Tahoe Hospital (CTH). Long Term Acute Care hospitals were essentially non-existent in 1979. Now, there are over 450 facilities nationwide that are licensed as LTACS (McDaniel, n.d.). The discharge plan I will be describing is for a 66-yr-old female who was admitted to (CTH) for revision of a chronic enterocutaneous fistula which was draining from her abdomen through a very large open wound. This fistula developed as a complication of a subtotal colectomy for ischemic bowel which was performed in February 2012. When the fistula first developed following the colectomy, she was admitted to LTACH with the goal of draining the fistula. Because this was unsuccessful, she returned to Carson Tahoe Hospital to determine the source of the leak and subsequently repair it. She is on a TPN diet, is NPO and is on contact isolation due to a Strep B infection in her wound. The revision surgery was done on April 29, when it was discovered that there was a 1.5 cm ulcerated and perforated area on the anterior portion of her stomach. This gastric percutaneous fistula was repaired and she will be discharged back to LTACH for ongoing IV antibiotics and wound care.…

    • 1413 Words
    • 6 Pages
    Better Essays
  • Powerful Essays

    The purpose of this Memorandum is to acquire a better understanding of the responsibilities of Health and Human Services Centers for Medicare and Medicaid Services (the “Agency,” or “CMS”), Provider Reimbursement,1 and the Provider Reimbursement Review Board (the “PRRB” or “Board”). This memorandum focuses on (1) recent Medicaid and Medicare legislation; (2) the process of becoming a Provider;2 (3) the reconsideration process for prospective Providers; (4) the appellate review process of Provider reimbursement decisions; (5) the role of the PRRB; and (6) alternatives to administrative or appellate review of Provider reimbursement decisions.…

    • 4538 Words
    • 19 Pages
    Powerful Essays
  • Good Essays

    High 30-day readmission rates have become problematic for many facilities. The Centers for Medicare & Medicaid Services (CMS) have put emphasis on readmission rate reductions for hospitals (“Readmissions Reduction Program”, n.d.). The stress of high readmission rates weighs heavy on facilities as a result of the Affordable Care Act (ACA) which requires CMS to reduce payments to hospitals with excess admissions (“Readmissions Reduction Program”, n.d.). Incorporating Project Re-Engineered Discharge (RED) as part of the discharge process at a small hospital will impact the facility’s readmission rates. Utilizing an evidence based practice (EBP) model can assist advance practice nurses (APN) in creating a system change. A synthesis of evidence…

    • 1565 Words
    • 7 Pages
    Good Essays
  • Good Essays

    Recovery Audit Case Study

    • 795 Words
    • 4 Pages

    Furthermore, as we all work to implement the new requirement and assuring the accuracy of data as well as prevention of the RAC audit, the Centers for Medicare Services can examine the reports and lessons learnt for improvement that could have been made by the RAC program and purse other efforts to reduce and eliminate improper payments. Sometimes change can bring about the growth of a successful empire but, with CMS initiating the RAC program, it won’t be a hundred percent guaranteed that it will be…

    • 795 Words
    • 4 Pages
    Good Essays
  • Good Essays

    Medicare reimbursements for physicians and for hospitals have some similarities and have some major differences. In one regard they are the same in the sense providers and hospitals are both federally funded for services and not state funded. Another similarity is that on average they are only given a percentage of the payment from the government leaving sometimes a gap in money from what services truly cost. Where the difference lays are how they are reimbursed for services provided. A physician in a practice will come and see a patient. They will bill for the time, level of care and acuity actually provided to the patient. They will then bill for the procedure they provided for that patient. They will receive a percentage that Medicare will pay for services provided. The physicians use Current Procedure Terminology (CPT) codes and health care common procedural coding system (HCPCS). These codes when imputed score the fee schedule and give a physician Relative Value units to determine a payment. This service is more of a fee for service approach. In a hospital you are reimbursed by a Diagnostic related group (DRG). The hospital uses DRG codes by matching the highest acuity diagnosis. The CPT’s will fall into the patients visit and grand total, but will only get paid for the price of that DRG and not the CPT. An example of this would be if patient comes in for heart failure. This patient is given a DRG of heart failure if they meet the criteria of a low ejection fraction. Throughout their stay, they received several codes that fall within the DRG. “At Wellstar there are three codes ranging from DRG 291 which pays close to 9,000 dollars and DRG 293 which pays nearly 4,000 dollars.” (S. Shuggs, personal communication, October 14, 2012) In a hospital setting we must be very efficient with care, because the hospital will only receive payment for that specified…

    • 423 Words
    • 2 Pages
    Good Essays
  • Satisfactory Essays

    This question is difficult to answer for me because I have been in and out of the program for various reasons over a number of years and originally began the program in 2007 right after I got out of the Navy, so I failed to pay much attention to the health care industry at the time to be honest. At the time I was going through some personal struggles that over road all my other trains of thoughts because they affected my life so insanely. In 2006 my medication prices doubled without insurance. Thank God that Publix started giving certain antibiotics out for free with prescriptions during the cold season. They were working on a plan in legislature to make medicine easier to afford. Frencher (2006), “The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) provides universally available prescription drug benefits to elderly and disabled Medicare beneficiaries for the first time” (para. 1).…

    • 308 Words
    • 2 Pages
    Satisfactory Essays
  • Better Essays

    References: [1] L. Sprague, “Hospital Oversight in Medicare: Accreditation and Deeming Authority,” NPH Issue Brief, no. 8, pp. 1-15, May 2005.…

    • 865 Words
    • 4 Pages
    Better Essays
  • Powerful Essays

    A searchable compendium of healthcare report cards, designed especially for consumers, and which includes comparative data on quality designed especially for healthcare organizations and providers by type of provider, is offered. This organization also provides access to different types of data primarily used for quality and utilization purposes. For instance, it sponsors the Healthcare Cost and Utilization Project (HCUP). This project provides access to a family of databases which contain public and private hospital care data, but accessing this data set requires an agreement in which limitations and provisions of data usage are summarized, and users (organizations) are required to cite AHRQ when using the data in reports. Finally, the AHRQ supports the Medical Expenditure Panel Survey in its provision of data on the cost and use of healthcare services and health insurance across the United States. This data’s main components are household data, which focuses on patients and their providers, and insurance data. Such data can be used for private planning, and to help policy makers have a better understanding of the nation’s healthcare needs and how best to meet them (Bronnert et al., 2010).…

    • 4348 Words
    • 18 Pages
    Powerful Essays
  • Good Essays

    The combined program (IVIP and Clubhouse Services), unlike the standard services, also involved three, one hour a week of courses and group which utilized cognitive behavioral therapy psychoeducation to address the disempowering beliefs and thoughts as well as identifying/modifying cognitive distortions members had about their ability to work and adapt into community (i.e. “I am terrible at work and I cannot perform my job” and “I never will be able to work like everyone else; I am inadequate”) (Lysaker et al., 2005). The researchers utilized The Bech Hopelessness Scale, The Rosenberg Self-Esteem Scale, and The Work Behavioral Inventory which is a 35 item tool designed to measure the quality of work values and outcomes of the…

    • 1333 Words
    • 6 Pages
    Good Essays
  • Good Essays

    Hospital Readmissions

    • 759 Words
    • 4 Pages

    The Centers for Medicare and Medicaid Services have taken on initiatives to improve quality of care for Medicare patients since the Affordable Care Act was passed in 2010. In 2012 CMS implemented a program called The Hospital Readmissions Reduction Program (HRR), this program is intended to improve health care for patients with Medicare to improve the quality of care that is provided versus the quantity of care. This program provides incentives to hospitals, which is intended to reduce costly and unnecessary readmissions (Centers for Medicare and Medicaid Services, 2016). The conditions that are currently being monitored by CMS for readmissions are heart attack, heat failure, and pneumonia. If hospitals have a high percentage of readmissions…

    • 759 Words
    • 4 Pages
    Good Essays
  • Powerful Essays

    Health Care Reform Paper

    • 1937 Words
    • 8 Pages

    The American healthcare system of today faces many issues and problems. The growing population of elderly and high rate of unemployment has left many Americans without any type of healthcare at all. To reform healthcare that has to first the infrastructure established that is sustainable for doctors, suitable for members, and costly enough to be sponsored. Hospitals are bulking up into huge systems, merging with one another and building extensive new doctor work forces. They are exploring insurance-like setups, including direct approaches to employers that cut out the health-plan middleman. WSJ 's Anna Mathews joins the News Hub to discuss the changing face of health care in the U.S. as a result of pressure to cut costs. AP Photo. On the other side, insurers are buying health-care providers, or seeking to work with them on new cooperative deals and payment models that share the risks of health coverage. And employers are starting to take a far more active role in their workers ' care. (Wilde-Matthews, 2011) This new and innovative plan does seem to be valid and more cost-efficient. The main issue with current health care plan and especially government mandated health care plan are the doctor’s reimbursement rates for procedures. Doctors argue that current reimbursement rates are too low, causes them to lose money, and force sub-par healthcare to members. Many argue…

    • 1937 Words
    • 8 Pages
    Powerful Essays
  • Best Essays

    There are many changes being made by the Affordable Care Act which will have an impact on Medicare. Affordable Care Act makes Medicare stronger as well as assists the elderly with taking responsibility of their health outcomes. The act will provide essential free assistances which include preventive services, yearly wellness appointments and a fifty percent price reduction towards prescription drugs for the individuals that are in the coverage gap called the donut hole. Medicare recipients can also work with their physicians to develop a personal prevention plan. Affordable Care Act impacts Medicare for the reasons that the elderly for no cost or little cost will receive more benefits than they have before. The intention of the act is to encourage improvement, trial analysis for forms of payment models and enhancements to the ways payments are made for basic health services, the promotion of patient centered support given by health institutions, reducing unnecessary inpatient stays and developing an incentive plan for practitioners, hospitals and additional health facilities so that the delivery of care is provided in an efficient manner. Affordable Care Act does not necessarily eliminate every issue associated with Medicare, but it is definitely a start. There are still changes that will have to be made in order to correct the continuing gaps amongst the amount of workforces that pay taxes into the Medicare and the amount of individuals that receive the assistance.There is also the issue of the increasing health care costs which will continue to jeopardize its purpose of being long term solution. Due to the ACA a lot more individuals will be able to afford health care benefits including safeguards which will assist them with keeping insurance at times when a critical health condition arises as well as…

    • 1871 Words
    • 8 Pages
    Best Essays
  • Better Essays

    Health Reform Impact

    • 1138 Words
    • 5 Pages

    These people are left with no healthcare coverage and are being penalized for not being able to afford it. The ACA also puts strain on business large and small. Some of these companies currently offer health care to their employees, but now that ACA has moved in the insurance companies are charging business more for their employee coverage. This causes the business to make critical decisions in order to keep health insurance for their employees they now have to increase the employees cost for the insurance, fire employees, ask employees to work less than 30 hours or ask employees to take a pay cut. This puts a huge strain on the economy because now we have more unemployed people, the employees that took a pay cut are no longer able to continue with their level of living, and those who had their hours cut are now without insurance, less pay and cannot afford insurance on their own. This is all terrible for the economy because there are less people spending, taking out loans, and putting money into…

    • 1138 Words
    • 5 Pages
    Better Essays
  • Good Essays

    Healthcare attributes

    • 666 Words
    • 3 Pages

    Completely expanded and updated to account for the latest changes in the U.S. health care system, this best-selling text remains the most concise and balanced introduction to the domestic health care system. Like its predecessors, it provides an accessible overview of the basic components of the system: healthcare personnel, hospitals and other institutions, the federal government, financing and payment mechanisms, and managed care. Finally, it provides an insightful look at the prospects for health care reform.…

    • 666 Words
    • 3 Pages
    Good Essays