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Hello Motivators,

 

Please write a response to the below post 300-500 words with 1-3 references, not the ones used by writer. Please do not repeat what writer say, use your own original thoughts. The attached document can be used as a reference  or help aid for the kind of response that will satisfy this task.  Thanks in advance.

 

Article

 

Citations and links: 

 

1) Carroll, J. (2011 Sept.). Tougher CMS Readmissions Rules Afflict Hospitals at a Bad Time. Managed Care Magazine. MediMedia. Retrieved from http://www.managedcaremag.com/archives/2011/9/tougher-cms-readmissions-rules-afflict-hospitals-bad-time.

 

2) Scheurer, D. (2015 Nov. 04). Medicare's Readmission Reduction Program Cuts $420M to U.S. Hospitals This Year. The Hospitalist. Society of Hospital Medicine. Retrieved from http://www.the-hospitalist.org/article/medicares-readmission-reduction-program-cuts-420m-to-u-s-hospitals-this-year/?singlepage=1

 

Summaries:

 

1) This article by John Carroll aims to address the issues with the Hospital Readmission Reduction Program (HRRP) and the time frame in which it was implemented. He states that not only are the new rules unfair to providers, but it is inherently discriminating against hospitals serving low-income groups that live in areas where too few doctors practice medicine (Carroll, 2011). He states that HRRP is afflicting hospitals during a time where economic pressures are already high, therefore making the 3% loss an even more significant penalty. Instead of pushing hospitals to better handle readmissions, Carroll fears that HRRP is not taking all incidences into consideration and will ultimately result in a decreased quality of care.

 

2) This article by Dr. Scheurer aims to show the benefits of HRRP. It brings light that although there is criticism and apparent disproportional penalties, the program is ultimately doing more good than harm. In fact, she states it has caused hospitals to pay more attention to transitions of care and avoidable readmissions, causing an overall decrease in 30-day readmission rates among Medicare recipients since the program began in 2012, in all types of hospitals (Scheurer, 2015). These numbers are great, but Dr. Scheurer also provides ways on how hospitals can further conform to this new program and better their readmission rates. 

 

Significant Stakeholders (that play a key role on each side):

 

The Obama Administration's ACA has several goals in mind, one of which is moving from volume to value in the Medicare system, which they are hoping the HRRP will do (Braman, 2015). These policymakers have the ultimate power, as they are in control of the standards that are set and expected to be met by hospitals and post-acute care providers. Any major changes in the program, such as whether to change the amount of the penalty, change the cap on penalties, change who should be penalized, etc., will require legislative action (James, 2013). 

 

Heart attack, heart failure, pneumonia, COPD, and hip/knee replacement patients, as they are the targets of the 30-day readmission findings. Their socioeconomic backgrounds are always coming into play.

 

Hospitals and their associated providers, executives, staff, etc. who are affected by the penalties accrued by not adhering to the HRRP standards.

 

Centers for Medicare and Medicaid Services (CMS), who actually issue the readmission penalties.

 

Certain states in the US are being disproportionately affected, such as Alabama, Connecticut, Florida, Massachusetts, New Jersey, etc.

 

The American Hospital Association fears that impoverished neighborhoods will have undermined care with the enactment of the HRRP. Nancy Foster, AHA's Vice President, considers Medicare's penalty for missing readmission targets "extreme" and discriminatory (Carroll, 2011). 

 

Post-acute care providers who require further clarified patient discharge information and are being held responsible by some hospital staff for the readmissions of their patients. 

 

The Medicare Payment Advisory Commission endorsed the continuation of the HRPP in its June 2013 report to congress, but made a number of recommendations on technical adjustments to the methodology (James, 2013)

 

The Problem:

 

1) Carroll sees the problem as the new policy itself, believing that it is too narrow and does not include all outside factors playing a role in readmissions. By implementing these penalties without taking into consideration the status of readmissions and the unpredictable nature of them, they are reducing financial resources to lower-performing hospitals which could have a negative impact on their delivery of patient care (Boccuti and Casillas, 2015). As it stands right now, the Risk Adjustment Factor for determining readmissions standards fails to include socioeconomic status. Carroll and others believes that this RAF needs to move away from a national standard and instead use a peer evaluation standard. 

 

2) Opposing Carroll, Dr. Scheurer believes that the problems stem from hospitals not adhering to the new law as well as they could. Hospital readmissions are costly and detrimental to both patients and taxpayers, and unfortunately costing Medicare more than $26 billion annually, $17 billion of which is related to readmissions that could have been avoided (Boozary, Manchin, and Wicker, 2015). Scheurer suggests that hospitals can further decline readmission rates if they continue to pay attention to transitions of care and avoidable readmissions, as "the penalties are unlikely to go away and are very likely to expand over time" (Scheurer, 2015). 

 

Solutions:

 

1) Carroll suggests that in order to make the HRRP better, it needs to be expanded in order to include outside circumstances that may be causing readmissions and/or special cases, such as cancer patients and/or patients with weakened immune systems, which need to be closely monitored. He states that in order to adapt successfully, many things need to be changed, including changing and improving the way information about patients is shared among hospitals, nursing homes, and other institutions as patients migrate from one place to the next. Adapting the law in a way that penalties are waived for readmissions for unforeseeable accidents, patients that need to return for f treatments (such as chemotherapy), or for patients that were not receiving the correct post-acute care would make it so that hospitals are more willing to cooperate with the new policy. In fact, this even has government support. In 2014, legislators in the 113th Congress demonstrated bipartisan support for addressing this issue by introducing two bills supported by the AHA that would have required CMS to include sociodemographic factors in the HRRP's risk-adjustment methodology (Demehin and Ward, 2015). This is definitely feasible, and may in fact further lessen readmission costs by adding a higher compliance rate. 

 

2) Dr. Scheurer suggests that in order to fix the problem from within, hospitalists need to start adjusting the way they are looking at the new policy. It was found that many hospitals are preferring to pay penalties over reducing readmissions in any equilibrium, which is definitely not helping with the problem at hand (Zhang et. al., 2015). Sheurer suggests looking at how hospitals fare within their individual states and finding out if they are above or below average in the amount, continuing to focus on exemplary case transition protocols, policies, and programs within each hospital system, because the penalties are unlikely to go away and are very likely to expand over time, and supporting advocacy efforts toward improving risk adjustment methodologies (Sheurer, 2015). This method of improving readmission statistics probably has more government official backing as it decreases the costs on policymakers, however it may also be hard to implement because of the supposed outside factors. Needless to say, it could definitely be a solution as identifying and sharing best practices has shown to decrease heart failure readmission rates by an average of 13%, would could be assumed for other readmissions as well (Demehin and Ward, 2015). 

 

The Ultimate Question:

 

How can policymakers lower unnecessary hospital readmissions without lowering patient quality of care?

 

My Preferred Solution:

 

I would have to say I agree with John Carroll and his preferred solution. The current HRRP is not taking into account accidental situations that cause patients to be readmitted. Say a patient was first admitted for a heart transplant, then after being discharged they come into contact with someone who gives them pneumonia. This is something completely out of the control of the hospital, but they are still being penalized for these types of readmissions. Expanding the HRRP to consider socioeconomic factors would provide a better understanding of the effect of social factors on publicly reported rates used for hospital comparison, which is important in order to help target quality improvement efforts to reduce the impact of social factors on readmissions and to support hospital efforts around caring for vulnerable populations (Nagasako et. al., 2014).Simply trying to promote better compliance within the hospital rather than taking notice of outside factors does not convince me that this tactic is worthwhile. Government officials and policymakers ultimately have control over this situation, as they hold the power to expand this reform and improve compliance. This is definitely a nation-wide issue/concern, as quality of care for these readmitted patients is being threatened due to the threat of penalties. The financial aspect of expanding the reform may at first take a hit, but ultimately readmission costs will continue to decrease as hospitals are no longer feeling the overwhelming threat of penalties and can focus on providing better care for those that absolutely need it. The window of opportunity for this key issue is opening and will continue to open as long as all factors are being accounted for. 

 

Other Resources:

 

Boccuti, C, & Casillas, G. (2015 Jan. 29). Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. The Henry J. Kaiser Family Foundation. WorldPress.com VIP. Retrieved from http://kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/

 

Boozary, A.S., Manchin III, J., & Wicker, R. E. (2015 July 28). The Medicare Hospital Readmissions Reduction Program Time for Reform. The Journal of American Medical Association, 314(4): 347-348. doi: 10.01001/jama.2015.6507

 

Braman, S. S. (2015). Hospital readmissions for COPD: We can meet the challenge. Journal of the COPD Foundation, 2(1): 4-7. doi: dx.doi.org/10.15326/jcopdf.2.1.2015.0130

 

Demehin, A., & Ward, M. (2015 May 11). Rethinking The Hospital Readmissions Reduction Program. Trustee Magazine. The Health Reform. Retrieved from http://www.trusteemag.com/articles/868-rethinking-the-hospital-readmissions-reduction-program

 

James, J. (2013 Nov. 12). Medicare Hospital Readmissions Reduction Program. Health Affairs Magazine. Project Hope. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102.

 

Nagasako, E. M., Reidhead, M., Waterman, B., & Dunagan, W. C. (2014 May). Adding Socioeconmoic Data To Hospital Readmissions Calculations May Produce More Useful Results. Health Affiliation (Millwood). 33(5): 786-791. doi: 10.1377/hlthaff.2013.1148

 

Zhang, D. J., Gurvich, I., Albert Van Mieghem, J., Park, E., Young, R. S., & Williams, M. V. (2015 May). Hospital Readmissions Reduction Program: An Economic and Operational Analysis.  Management Science. doi: 10.2139/ssm.2366493

 

 

 

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    Hello Motivators,

    Please write a response to the below post 300-500 words with 1-3 references, not the ones used by writer. Please do not repeat what writer say, use your own original …