In An Effort To Reduce The High Costs Of Health Care

In An Effort To Reduce The High Costs Of Health Care Health Care Exec

In an effort to reduce the high costs of health care, health care executives, physicians, and clinical staff establish guidelines to minimize the rates of readmissions for patients. While certain medical conditions may require that patients are readmitted into health care organizations, for less urgent or extensive medical conditions, ensuring that health care service is administered effectively the first time will go a long way in minimizing readmission. From a financial standpoint, patient readmissions constrict health care services, resources, and staff that would otherwise be used to treat new patient cases. From effective health care delivery, a patient who is readmitted may be an indication of poor quality health care delivery, ineffective process workflows, or inefficient patient care.

Paper For Above instruction

As the chief executive officer (CEO) of a hospital, addressing the persistent challenge of patient readmissions is critical not only for improving patient outcomes but also for aligning with financial and regulatory incentives, particularly those associated with Medicare reimbursements. Medicare’s policies, notably the Hospital Readmissions Reduction Program (HRRP), penalize hospitals with higher-than-expected Readmission rates for certain conditions, such as heart failure, pneumonia, and chronic obstructive pulmonary disease (COPD) (Centers for Medicare & Medicaid Services [CMS], 2016e). Consequently, reducing readmissions is a strategic priority that can enhance hospital performance, reduce financial penalties, and improve overall quality of care. This paper delineates two specific strategies—enhanced discharge planning and post-discharge follow-up—that I would implement to mitigate readmissions, supported by relevant literature and best practices.

Enhanced Discharge Planning

One of the paramount strategies to reduce readmissions is to implement comprehensive discharge planning processes. Discharge planning involves preparing patients for safe transition from hospital to home or other care settings through detailed education, medication reconciliation, and coordination with outpatient providers (Dye & Garman, 2015). Research indicates that effective discharge protocols significantly decrease preventable readmissions, particularly when they encompass patient education about medication management, warning signs, and clarity about follow-up appointments (Butcher, 2013). This approach ensures that patients understand their treatment plans, medications, and self-care instructions, thereby reducing the likelihood of clinical deterioration that leads to readmission.

Implementing multidisciplinary discharge teams—including nurses, physicians, pharmacists, and social workers—can tailor discharge processes to individual patient needs, address potential barriers to adherence, and schedule timely post-discharge follow-up (Dye & Garman, 2015). Hospitals can leverage health information technology (HIT), such as electronic health records (EHRs), to facilitate information sharing and ensure that community providers are informed about patient discharges. Evidence suggests that hospitals adopting these strategies demonstrate lower readmission rates and better patient satisfaction scores (Chernew, 2016).

Post-Discharge Follow-Up

The second strategy involves proactive post-discharge follow-up, which has been shown to significantly curb preventable readmissions (U.S. Department of Health and Human Services [HHS], 2016a). This can take the form of scheduled telephone calls, home visits, or telehealth interventions within 48 to 72 hours of discharge. The goal is to assess patients’ health status, reinforce medication adherence, clarify post-discharge instructions, and address any emerging issues promptly. Studies show that early follow-up reduces the risk of clinical deterioration and prevents unnecessary readmissions, especially in high-risk populations (Chernew, 20116).

Furthermore, integrating follow-up care with community-based providers, such as primary care physicians and post-acute care facilities, ensures continuity of care—a vital element in minimizing gaps that lead to readmissions (Butcher, 2013). Such integration aligns with the Patient-Centered Medical Home (PCMH) model, promoting coordinated, comprehensive care that emphasizes prevention and proactive management of chronic conditions (Dye & Garman, 2015).

Impact of These Strategies on Medicare Reimbursements and Hospital Performance

Implementing these strategies aligns with the shifting landscape of value-based care, where hospital reimbursement is increasingly tied to quality metrics rather than volume (Chernew, 2016). The HRRP imposes financial penalties on hospitals with excessive readmission rates, which directly impacts hospital revenues. Conversely, hospitals that successfully lower readmission rates can avoid penalties and even receive bonus payments under programs such as the Bundled Payments for Care Improvement (BPCI) and the Medicare Shared Savings Program (MSSP) (HHS, 2016a).

By reducing preventable readmissions, hospitals not only improve their performance metrics but also strengthen patient satisfaction and safety. These improvements translate into better hospital ratings, increased patient loyalty, and potentially higher reimbursements from Medicare and other insurers. Furthermore, the focus on evidence-based discharge planning and follow-up care fosters a culture of continuous quality improvement that benefits organizational sustainability in a rapidly evolving healthcare environment.

Conclusion

In conclusion, as hospital CEO, I would prioritize the implementation of comprehensive discharge planning and early post-discharge follow-up to reduce patient readmissions. These strategies are supported by literature demonstrating their efficacy in improving patient outcomes and decreasing preventable hospital returns. Aligning these initiatives with Medicare reimbursement policies ensures financial benefits for the organization while enhancing care quality. Emphasizing coordinated, patient-centered care, leveraging health IT, and fostering multidisciplinary collaboration are essential components of a successful readmission reduction program. Ultimately, these efforts promote a sustainable, high-quality healthcare delivery model aligned with current healthcare reforms and value-based payment systems.

References

Chernew, M. E. (2016). Payment reform: Two payment models will dominate the move to value-based care. In Futurescan healthcare trends and implications: 2017–2022 (pp. 12–15). Health Administration Press.

Centers for Medicare & Medicaid Services. (2016a). Community-based care transitions program. Retrieved from https://innovation.cms.gov/initiatives/CCTP

Centers for Medicare & Medicaid Services. (2016e). Readmissions reduction program (HRRP). Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Reducing-Unnecessary-Readmissions

Dye, C. F., & Garman, A. N. (2015). Exceptional leadership: 16 critical competencies for healthcare executives (2nd ed.). Chicago, IL: Health Administration Press.

U.S. Department of Health and Human Services. (2016a). Provider preventable conditions. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Provider-Preventable-Conditions.html

U.S. Department of Health and Human Services. (2016e). Readmissions reduction program. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementStudies/Readmission-Reduction-Program

Butcher, L. (2013). Hospitals strengthen bonds with post-acute providers. Healthcare Finance News. Retrieved from [link]

(Note: The above references are examples; replace with actual sources when finalizing the document.)