The continued quality improvement programs incorporated in HH continue to prove the appropriate care deleting unnecessary treatments. In turn, maximizing the patient’s healthcare benefits or value results in cost savings and higher quality care (Porter & Lee 2013). According to HH’s Brenda Brooks, “we (case management/quality assurance) have merged supply driven, fragmented care into a patient outcome delivery system, assisting the consumer in maximizing benefits with high value care. An example of a chronic back pain, expensive and disabling ailment, patient provides an excellent example of previously fragmented care receiving portions of care from various clinicians and locations resulting in unneccesary or duplicate treatments, such as x-rays or medications.…
Patient access is an important factor to a healthy population, the goal is to ensure that patients receive the care they need at the appropriate time, and in the right setting. Despite billions of dollar spent on the VA health care system and various efforts to improve veteran’s access to care, the VA continues to face patient access issues that affect Veteran’s care. Veterans are waiting a long period of times for care; which means they are being diagnosed late, readmitted for hospitalization, and some veterans…
Surgical Site Infections are related to delayed healing, increased patient morbidity and mortality, increased hospital stay, readmission and facility costs. Anderson et al. (2014) explains that these infections extend a patients hospital stay on average of 7 to 11 days and cost roughly $3.5 to $10 billion annually in healthcare expenditures according to the consumer price index for inpatient hospital services. Most of these costs are not reimbursed by insurance because they fall within the 30-day readmission rate. Shepard et al.…
According to the article, “Utilization Management: A European Perspective” (2014), utilization management has been described as an organization wide, interdisciplinary approach to balancing quality, risk, and cost concerns in the provision of patient care. The purpose of utilization management is to identify, monitor, evaluate, and resolve issues that could result in inefficient delivery of care; or impact on resources, services, and patient outcomes (Plebani, Zaninotto, & Faggian, 2014). The main goal of utilization management is to maintain the quality, and efficiency of health care delivery by caring for patients at the appropriate level, coordinating health care benefits, ensuring cost-effective treatment benefit and the provision of medical needs (Plebani, Zaninotto, & Faggian, 2014). The article (2014) also states that due to the increasingly dominant environment of cost containment, utilization management is vital for achieving a balance between efficiency, and quality. The utilization management program for the University of Michigan Health System, or U of M hospital will be discussed.…
Introduction The goals of the Patient Protection and Affordable Care Act (ACA) has propelled all primary care practices into new and uncharted territory. To meet the primary goals of the ACA, primary care physicians would play a pivotal role in improving the health of Americans and lowering the costs of the health care they receive. The legislation plans to accomplish this by moving from fee-for-service to value-based reimbursement. The value of the value-based reimbursement is based on improving the quality of care as demonstrated by improved quality measures.…
Describe different types of readmissions and their main reasons. Who comes back to the hospital? a. Planned and unplanned readmissions, especially in Medicare patients. b. Whether the readmissions are associated with their initial diagnoses and treatments or not. If yes, how many percentages that would be?…
We undertook a clinical study approved by the local Research Ethics Committee1 of 200 patients in a postoperative ward of the Cancer Centre, Oxford University Hospitals NHS Trust, Oxford, U.K. Patients were discharged to the ward following upper-gastrointestinal (GI) cancer surgery. This group of patients was selected for our study because of the high incidence (up to 20%) of postsurgical complications, whereby patients can deteriorate physiologically, resulting in adverse outcomes such as readmission to the intensive care unit (ICU) or death. Readmission to the ICU is prolonged and the mortality rate of such patients is high. These adverse events may occur when the physiological condition of the patient is not recognized or acted upon early…
Identify your selected problem in the first line of your posting and post your research question. “Relationship between effective Discharge Planning and Psychiatric Hospital Readmission Rate” Does effective discharge planning reduce the rate of readmission to a psychiatric hospital? According to Burns and Grove (2005), a correlational study examines the relationship between two research variables within a known situation. A correlational study determines if two variables are correlated. It also determines if an increase or decrease in one variable relates to an increase or decrease in the other variable.…
Although many of us, when we hear the name Affordable Care Act (ACA) we right away think about low coverage, better access, and affordability but there’s so much more to it. Physicians are now being faced with having to provide better patient safety and quality of care. Thanks to Medicare’s Hospital Value-Based Purchasing Program (VBP), the quality of care provided to patients by hospitals is now measured through the use of quality measures and the patients’ overall satisfaction of care. Since the program was implemented, the ACA has showed significant results in the healthcare industry. For example, by improving patient safety and quality of care, adverse effects have lowered significantly.…
Avoidable readmissions come at a great cost to patients/residents, healthcare providers, and taxpayers, a $25 billion cost to be exact. This is the estimated amount that avoidable readmissions cost the nation on a yearly basis and is one of the largest contributors to the enormous growth in national health care costs. Readmissions are the result of several difference aspects from incomplete treatment, poor post-acute care, lack of coordination in discharge planning, or even the unavailability of social supports. Recently the Center for Medicare and Medicaid (CMS) began penalizing hospitals for avoidable readmissions as part of the hospital readmission reduction program supported by the Affordable Care Act (ACA). Now that these penalties have become the “law of the land”, CMS is moving onto the next phase of in care continuum, post-acute-care, specifically skilled nursing facilities (SNFs).…
A short literature review is included in the background section of the article, and it is relevant to the study. It provides information about the expenses related to readmission and the need of developing the interventions to reduce readmission rates. Poor communication, gaps in follow-up care, discharging patients with pending tests results, and inadequate patient education and discharge instructions have impacted the readmission rate. However, the authors of the article did not include any information about previous studies regarding the benefits of the NP’s involvement in patient care. 6b: The primary sources of information were mostly used in the literature review.…
4. Supporting argumentation for the proposed changes The barriers to action There used to be significant resistance and minimal incentive for preventing readmission in many layers of health care. It is now true that there has been more awareness and attention to the problems and issues regarding readmission to acute-care hospital, regardless of location of care such as ambulatory care or SNF. Therefore, it is also true that numerous researches and papers published to solve this issue by various interventions and programs reflect the significance of problems and emergent attention, especially administrative and management level that is more conscious about the potential financial impact from readmissions.…
The article further reveals that there lacks a sufficient cause to determine the reasoning behind the sizeable difference in charges. The Affordable Healthcare Act seeks to curtail this issue by adding this aspect of transparency. There are future hopes that insurance companies and hospitals can enter into further negotiations to reduce this cost, and provide better services to its patients. This is important as “unexpected health care bills continue to be a leading cause of financial ruin for American families” (Young, 2013). This issue is above all is important, as the patients are recovering from what condition forced them to seek treatment.…
Lack of patient compliance with health and medicine regimen cost the United States healthcare system billions of dollars contributing to rising healthcare costs (McGuire & Iuga, 2014, p. 35). This behavior translates to unscheduled outpatient visits such as emergency room utilization and high inpatient readmission rates. Patients with chronic diseases such as Congestive Heart Failure (CHF), Asthma, Coronary Artery Disease (CAD), and Chronic Obstructive Pulmonary Disease (COPD) experience high readmission rates due to poor compliance with plan of care, which takes away critical healthcare resources for patients with acute health issues (Mahoney, Ansell, Fleming, & Butterworth, 2008, p. 2). The high readmission rate often results in scheduled…
Reimbursement within the healthcare system is changing consistently and many issues and concerns can arise with those changes. Memorial Sloan-Kettering Cancer Center receives reimbursement from a variety of payers on a state, federal and private pay level. An example of one of the types of reimbursements used at Memorial Sloan-Kettering (MSK) is “Fee-for- service reimbursement”. With this type of reimbursement providers receive payment for each service that is made (Hagland). There are advantages to this type of method such as independence to policy holders and some disadvantages are the risk of uncertainty and high copays and deductibles for patients.…