Lessening Re Hospitalization of Medicare and Medicaid Patients

¶ … Preventing 30 Day Readmission on Medicare and Medicaid Patients

One of the most costly and common phenomenon in the modern healthcare system is the increased rates of readmission to hospital of Medicare and Medicaid patients within a short period after discharge i.e. usually within the first 30 days. These readmissions are usually caused by progression of chronic diseases among these patients as well as insufficient post-discharge care. Actually, insufficient post-discharge care is the major factor contributing to these preventable re-hospitalizations. Therefore, reducing the rates of readmissions to hospital of Medicare and Medicaid patients requires developing and implementing a new or enhanced plan for patients' follow-up after discharge. According to the findings of a recent survey, 22% of patients admitted to hospitals are either re-hospitalized or visit an emergency department within the first month after discharge (Harrison et al., 2011, p.27). This plan focuses on preventing readmission of these patients through post-discharge care based on follow-up.

Current Problem Requiring Change

As previously mentioned, the healthcare environment is increasingly characterized by high rates of readmission of Medicare and Medicaid patients since they suffer from chronic diseases. These high rates have partly been attributed to progression of the chronic illnesses but largely influenced by inadequate post-discharge care. The post-discharge care is insufficient because of poor communication between the patient and the health care team during and after discharge (Harrison et al., 2011, p.27). Recent surveys have indicated that approximately 22% of admitted Medicare and Medicaid patients are either re-hospitalized or visit and emergency room within 30 days of discharge if they don't die. The increased readmission has considerable impact on the health and well-being of these patients in addition to increasing health care costs. Therefore, it is increasingly important to develop effective plans for post-discharge care in order to improve patient outcomes and lessen health care costs.

Obtaining Approval and Support from Leadership and Staff

The first step towards the implementation of this plan on preventing 30 day readmission on Medicare and Medicaid patients is obtaining required approval and securing support from the organization's leadership and fellow staff. This will involve conducting a meeting with the leadership team in which the rationale and positive effects of the proposed plan will be discussed. These discussions will be carried out in a board meeting, which will review the organization's current environment and practices as well as examine the needs for implementing an evidence-based project. Similarly, securing support from fellow staff will entail discussing the current best practices in lessening readmission rates and how these practices will be incorporated in the organization. During this process, the roles and responsibilities of the staff in the implementation of the proposed project will be discussed and clarified.

Explanation of Proposed Solution

The proposed solution for preventing 30 days readmission of Medicare and Medicaid patients is a process or procedure that focuses on post-discharge care through follow-up phone calls after discharge and follow-up appointments with primary care physicians. Generally, follow-up phone calls by nurses after patient discharge have widely been adopted as a means of enhancing patient satisfaction and outcome while ensuring continuity of care (D'Amore et al., 2011, p.249). In this case, the follow-up phone calls and follow-up appointments with primary care physicians will be implemented as part of the health plan for improved patient outcomes through reducing readmission rates. These phone calls will be made by trained nurses and appointments held with primary care physicians in an appropriate and convenient setting for the Medicare and Medicaid patients.

These measures of post-discharge care will achieve desired goals and objectives by providing education and support to patients. During this process, the primary care physicians and nurses will address any emerging issues associated with the patient's condition. They will also educate patients on appropriate self-management measures, lifestyle changes, and compliance with medications. As a result, patients will adhere to prescriptions for medications and take necessary measures to avoid exacerbations and unprecedented events. This will eventually contributes to reduced readmission rates by preventing patients' re-hospitalization.

Rationale for Proposed Solution

The proposed solution was selected because of evidence in current literature and studies that adequate and effective post-discharge care helps in lessening the rate of re-hospitalization of patients, especially those with chronic diseases. According to Constantino et al. (2013), post-discharge telephonic calls and care have helped in lessening the number of readmissions and emergency room visits for Medicare patients (p.310). The interventions help in achieving this through increasing visits to physicians' office, which implies that these patients seek help from physicians resulting in avoidance of re-hospitalization. The case for this proposed solution is also supported by vital evidence in literature that non-medical risk factors play a major role in early readmission of Medicare and Medicaid patients to hospitals (Iloabuchi et al., 2014, p.489).

Implementation Logistics

The integration of this proposed change or solution into the existing organizational structure, culture, and workflow will entail changing the organization's policy and operating procedures. The organization's leadership will develop a policy change in which this proposed change is included as a fundamental component of its health care processes and procedures. Moreover, the leadership will develop a framework for conducting staff education and providing necessary resources for implementing the proposed change. The establishment of this framework will include providing necessary educational materials and technological and assessment tools for the training and implementation process. Nurses will work with their supervisors to execute the proposed solution while documenting any emerging issues or concerns during execution. Nurses and supervisors will provide important feedback, which will be used in evaluating the effectiveness of the solution relative to desired goals and expectations. In collaboration with the supervisors, the organization's leaders will be responsible for initiating, executing, and assessing the implementation of this solution.