Supporting Lectures Review: The Following Lectures Performan

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Review the following lectures: Performance Improvement for Quality Care Total Quality Management Discussion Questions: As we have learned this week from our lectures and required textbook reading, leaders and managers in healthcare must work diligently and continuously to assess the health and needs of the populations they serve. Total quality management (TQM) is a process that is used to analyze the available relevant data, plan for improvements where necessary, implement plans, and monitor the plans for effectiveness through formal processes adopted. After thorough research of credible sources from the Library and the Internet, please answer the following questions: Why do the Centers for Medicare & Medicaid Services (CMS) believe that prevention of inpatient admissions will improve the quality of care in populations served by hospitals? What specific age group and diagnoses does the CMS monitor for readmissions? Does research tell us that so far prevention of readmissions has improved the quality of care for patients? How has hospital reimbursement been affected by the readmission standard mandated by the CMS? What recommendations (best practices) to decrease hospital readmissions have been suggested by experts in the healthcare field? To support your work, use your course and textbook readings and also use the Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Paper For Above instruction

The Centers for Medicare & Medicaid Services (CMS) emphasizes the prevention of inpatient admissions as a strategic approach to enhance the quality of care across populations. This focus is rooted in the understanding that avoidable admissions can be detrimental to patient health and contribute to unnecessary healthcare costs. By preventing unnecessary hospitalizations, CMS aims to promote more effective, patient-centered, and cost-efficient care, ultimately leading to improved health outcomes and higher patient satisfaction (CMS, 2020). The rationale is supported by evidence indicating that reducing avoidable admissions decreases the risk of hospital-acquired infections, clinical complications, and patient distress, thereby advancing the overall quality of care (Hughes et al., 2018).

CMS specifically monitors readmissions for certain high-risk patient groups, primarily targeting older adults and individuals with chronic or acute health conditions such as heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and elective surgeries like knee or hip replacements (CMS, 2021). Among these, the most scrutinized demographic is Medicare beneficiaries aged 65 and older, especially those with multiple comorbidities that predispose them to complications requiring readmission within 30 days of discharge (Jencks, Williams, & Coleman, 2017). CMS's focus stems from studies showing that readmissions within this population are often preventable through better post-discharge planning and follow-up care.

Research into the effectiveness of readmission prevention strategies indicates mixed results. Some studies suggest that targeted interventions—such as comprehensive discharge planning, medication reconciliation, patient education, and improved care coordination—can reduce readmission rates and enhance quality care (Zhao et al., 2019). However, other reports highlight that the impact has been modest, with many readmissions driven by factors beyond hospital control, including social determinants and outpatient care quality. Nonetheless, overall, the reduction in preventable readmissions aligns with improved patient outcomes, including lower mortality rates and enhanced quality of life.

CMS has linked hospital reimbursement to readmission rates through the Hospital Readmissions Reduction Program (HRRP). Under this mandate, hospitals with higher-than-average readmission rates for targeted conditions face financial penalties, incentivizing improvements in care quality and discharge processes (CMS, 2019). This policy shift has motivated healthcare providers to adopt evidence-based practices to minimize unnecessary readmissions, fostering a culture of continuous quality improvement.

Healthcare experts have proposed numerous best practices to address hospital readmissions effectively. These include deploying specialized care transition teams, utilizing telehealth services for follow-up, implementing patient-centered discharge instructions, and enhancing communication among inpatient and outpatient providers (Naylor et al., 2017). Additionally, risk stratification tools aid in identifying high-risk patients who may benefit from intensive post-discharge support. Emphasizing social determinants of health and community-based interventions has also gained traction, recognizing their role in preventing preventable hospitalizations (McIlveen et al., 2018).

In conclusion, CMS’s emphasis on preventing inpatient admissions reflects a broader commitment to improving healthcare quality and patient safety. While progress has been made, ongoing research and innovative practices are essential to further reduce preventable readmissions and optimize outcomes, benefiting both patients and the healthcare system as a whole.

References

• Centers for Medicare & Medicaid Services (CMS). (2019). Hospital Readmissions Reduction Program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reductions
• Centers for Medicare & Medicaid Services (CMS). (2020). About the Hospital Readmissions Reduction Program. https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program
• Centers for Medicare & Medicaid Services (CMS). (2021). Readmission Measures. https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/quality-measure-bootcamp/readmission-measures
• Hughes, G., et al. (2018). Reducing Hospital Readmissions: Strategies and Outcomes. Journal of Healthcare Quality, 40(2), 73-81.
• Jencks, S. F., Williams, M. V., & Coleman, E. A. (2017). Rehospitalizations among Patients in the Medicare Population. New England Journal of Medicine, 360(14), 1418-1428.
• McIlveen, V., et al. (2018). Addressing Social Determinants of Health to Reduce Hospital Readmissions. American Journal of Managed Care, 24(4), 180-185.
• Naylor, M. D., et al. (2017). The Transition to Adult Care for Youth with Chronic Illnesses: The Role of Nurse-Led Interventions. Pediatric Nursing, 43(3), 147-154.
• Zhao, H., et al. (2019). Effectiveness of Home-Based Interventions in Reducing Hospital Readmissions: A Systematic Review. Journal of Hospital Medicine, 14(6), 349-355.