December 7, 2014
Navigator programs provide safe and effective movement of a patient across the care continuum, improve self-management of patient care and enhances patient practitioner communication. In 2005, President Bush signed into law the Patient Navigator Outreach and Chronic Disease Prevention Act of 2005. “The new law authorizes the appropriation of $25 million over five years for demonstration programs to provide patient navigator services to improve health outcomes” (Darnell, 2007). Northern Arizona Healthcare’s Congestive Heart Failure program will benefit from a patient navigator because of its potential to improve health outcomes and reduce costs. “One obvious avenue for significant cost savings to the health care system is to prevent episodes where health care costs the most: hospitalizations and hospital readmissions. Since a major proportion of chronic diseases are managed in community-based primary care, it stands to reason that to have an impact on managing the overall costs of chronic disease care, prevention of expensive hospitalizations should be one of the major goals of disease management” (Esperat & Flores, 2012).
The Centers for Medicare & Medicaid Services (CMS) began penalizing hospitals for readmissions within 30 days starting in the year 2012. “Medicare will use the fines to try to decrease the rates of patients leaving hospitals only to be readmitted within a month because of the same illness” (Sells, 2012). The mean cost per congestive heart failure (CHF) readmission is $13,000, with a 25.1 percent readmission rate. This is 118 percent the cost of an initial admission for CHF, which costs $11,000 on average. “Post-acute home care is often shared among informal caregivers and formal service providers. A study showed that up to 93 percent and 63 percent of elderly patients received informal and formal services” (Li & Nancy, 2004). Informal caregivers assist the elderly with activities of daily living, instrumental activities of daily living, and are involved in the patients’ medical care. Formal services are services provided by hospitals, follow up by physicians or nurses, discharge plans and home health. “Patients who received home nursing services that monitored patients' conditions, medication compliance, and nutrition were less likely to experience hospital readmission than those who did not receive the services in 90 days” (Li & Nancy, 2004). Acknowledging that poor discharge outcomes are related to numerous reversible factors, including a lack of understanding of heart failure, poor treatment compliance, inadequate follow-up care, inadequate medical prescriptions, communication failure between patient and provider, patient navigator systems have enhanced the care of the patient.
“Heart failure is a major public health problem: its rising incidence and prevalence render it almost a global epidemic. Although advanced pharmacological intervention has improved the prognosis of heart failure, hospital readmission and mortality rates, particularly for hospitalized elderly patients, remain high” (Yu, Thompson, & Lee, 2005). A study done by (Phillips et al., 2009) says that approximately 700,000 Medicare Congestive Heart Failure patients are discharged per year with a readmission rate of 50%. Assuming a 25% reduction in readmission rates post discharge support with home visit or patient navigator could prevent 84,000 readmissions with an estimated reduction in Medicare payments of $424 million per year.
Developing a patient navigator program that involves education, treatment, discharge planning, frequent home visits, and follow up will decrease readmission rates, saving the hospital money and provide better post discharge care to the patients in the community. The cons of the program are those that can easily be overlooked as the benefits of the program outweigh the simple disadvantages of the program. Patient navigator systems are