Readmissions In Acute Care

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When a patient is admitted to any acute care setting, their discharge planning should begin at that very moment and should include family members, friends, and any other support the patient has available. In spite of all of the education provided to the patient and their support system by the physicians and nurses in order to prepare patients for a successful discharge from the hospital, there will always be unplanned readmissions. These admissions remain a major challenge for the healthcare system today. One of the major issues with addressing these unplanned readmissions is the fact that the causes for readmission are so varied and many different variables need to be taken into consideration. The reduction of readmissions to healthcare…show more content…
In the context of Medicare, readmissions have generally been defined as a patient’s being hospitalized within 30 days of an initial hospital stay” (James, Hall, Joynt, & Lott, 2013, p. 1). Readmission rates have become an important topic in the medical world. They are costing hospitals and other medical facilities reimbursement funds that could be allotted to sustain and/or improve other critical areas in said facilities. When hospitals are known to have a higher than average readmission rates this could be an indication that adequate care is not being provided to patients or there is gap in the coordination of discharge planning for the patient. While not every readmission can be prevented, there are steps that hospitals and other facilities can take to reduce the readmission rates that are currently trending upward. Medicare and Medicaid take into account the number of readmissions a facility has in their determinant of how much they are going to reimburse for care provided to patients. The patient having a successful transition from the acute care setting to the home setting is a vital component that physicians, nurses, and all other healthcare staff members need to take into account and attempt to improve upon…show more content…
Medicare reimburses most healthcare facilities using the inpatient prospective payment system (IPPS), where hospitals are given a fixed amount based on the patient diagnosis, despite any actual resources utilized or care given ( James, et al., 2013). With the new reforms put in place, there is the potential for negative financial repercussions for facilities that higher a higher than normal national average readmission rate. The funds being reimbursed for services provided for patients can be denied or reduced based on a patient being readmitted within 30 days from their initial hospitalization. Any post-acute care provider with a readmission rate higher than the normal national average will face penalties of up to two percent of their expected Medicare reimbursement for care provided (Baicy, 2017). In 2011, patients that were discharged and returned for readmission within 30 days from an acute care setting represented over $41 billion in hospital costs. In excess of 2,200 hospitals incurred fines exceeding $280 million in reduced Medicare reimbursement in 2013 (Shih, Gerrard, Goldstein, Mix, Ryan, Niewczyk, Kazis, Hefner, Ackerly, Zafonte, & Schneider, 2015). The Medicare Payment Advisory Commission reports that 12% of readmissions could potentially be avoided, saving Medicare an estimated $1 billion (McIlvennan, et al., 2015). With the
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