Walker Exploratory Essay

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Exploratory Essay
Jamey L. Walker
Purdue University Calumet

Why is everyone so concerned with hospital readmissions? Who cares if they happen within 30 days of discharge from the last hospital admission? After all, aren’t people taught to go to the hospital when they are sick and admitted when they are ill enough? As a floor nurse it was my job to take care of patients until they were well enough to be discharged home. It was my hope that while they were admitted they learned something about why they were hospitalized and ways to keep it from happening to them again. I certainly would have liked to have had time while caring for them to teach them about their disease process, but anyone who has worked on a medical/surgical floor knows that there are days when this just isn’t possible. I confess that during those times I didn’t give readmissions a second thought. Then in May of 2013, I transitioned into the position of Case Management Specialist at a small community hospital. Suddenly, the readmitted patients, those “frequent flyers”, began to catch my eye. It was now my responsibility to make sure that these patients had the resources that they needed at time of discharge such as home health care, assistance with medications, appropriate durable medical equipment, or outpatient therapy orders in order to succeed at home and stay out of the hospital. In the beginning, my focus was in the present, as in “what does this patient need in order to safely be discharged from the hospital”, without much thought given to the next admission and what to do if they come back. This frame of mind continued until my coworker, who also happened to be the Readmissions Coordinator for the hospital, moved in to share an office with me. From then on, I began to be exposed to the world of readmissions on a daily basis, but still wasn’t sure what prompted all the buzz. I knew that her position was specifically created to help target patients who are at risk for or had been readmitted to the hospital within thirty days of their last hospital admission. What I didn’t know was pretty much everything else, so I decided to do a little research to figure it out. In my quest for information I found that on October 1, 2012 the Hospital Readmission Reduction Program was established through the Affordable Care Act. The program requires the Centers for Medicare and Medicaid Services (CMS) to reduce reimbursement to hospitals with high numbers of readmissions (White, Carney, Flynn, Marino, & Fields, 2014). CMS reports that 19.6% of patients are re-hospitalized within 30 days of their last discharge and that ¾ of these cases are avoidable equating to 12 billion dollars in excess healthcare costs. It was because of these statistics, that this program was put into place to attempt to boost healthcare cost savings by lowering payments to the offending hospitals (Hansen, Young, Hinami, Leung, & Williams, 2011).
Why are people readmitted? According to Naumann et al (2013), causes sited for readmission included inadequate symptom relief at time of discharge, post-op complication, inadequate follow up plan, awaiting definitive operation or procedure, inadequate initial treatment, progression of disease, missed diagnoses, and medication side effects. The authors also discussed a study which identified that mistakes in coding at time of admission have skewed the readmission rate percentages and that adequate coding is imperative in recognizing correct data for readmission. Furthermore, the study concluded that readmissions rates could be reduced or prevented by having adequate education given to the patient while admitted including written plans to help them understand and retain the information given.
Beginning in 2013, CMS began to look at three diagnoses with frequent readmissions including congestive heart failure (CHF), pneumonia, and acute myocardial infarction (AMI) as a basis for penalty given the number of readmissions in a