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Cost Reduction Plan for the Discharge Process

Business in Healthcare Nursing
by

Rochelle Quintana

on 17 July 2013

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Transcript of Cost Reduction Plan for the Discharge Process

Cost Reduction Plan for the Discharge Process
Problem
Hospitals are being fined for increased excess rates in 30 day
hospital re-admissions.
Why is it a problem? How does it effect clients or patients?
The problem: If we don't decrease the readmission rates in our facilities, the overall quality of care will decrease. Fines will continue to be implemented on a state and Federal level. This is a problem because increased rates of readmission cause financial instability which take a toll on our quality of care and environmental stress level. This changes how we provide care like : supplies availability, resources, staff shortages,employment opportunities, and budget cuts. This effects our patients, our nurses, and in turn our community.
A Budget Showing Savings for the Debt
Literature Review
Goals and Objectives for implementing the proposal
Potential Strategies for Solving the problem
Timeline for Implementation
What is the return on investment, profitability, and expected outcomes?
Carrying out the program in hiring a specialty nurse (such as the heart failure transition nurse) could save a lot of money. Putting in an investment by hiring nurses in specific areas where they are needed to specialize in the discharge and transition process, would not only save money by reducing readmission rates(which would be a profit to the hospital), but also improve patient satisfaction and quality of care.
By: Maylene Gonzalez
Bridget Pelaez
Ivan Peralta
Rochelle Quintana
References
Barriers
What is the Hospital Readmission Reduction Program (HRRP)?
It is a reimbursement penalty approach for general acute care hospitals that have re-admissions deemed "in excess" by CMS, the Center for Medicare, and Medicaid.
When did this begin?
Fiscal year 2013 (October 1, 2012)
Reduction is capped at 1% in 2013
2% in 2014, and
3% in 2015.

Reductions apply to total discharge reimbursement.
- BUT re-admissions deemed excess are determined using 3 specific conditions
(Acute Myocardial Infarction, Heart Failure, and Pneumonia.
The Chief complaints named are among the leading causes of admission, death, and disease in our Nation.
Part of "Medicare to Penalize 2,217 Hospitals for Excess Readmissions" written by Jordan Rau; October 12 2012
"More than 2,000 hospitals — including some nationally recognized ones — will be penalized by the government starting in October because many of their patients are readmitted soon after discharge, new records show.

Together, these hospitals will forfeit more than $280 million in Medicare funds over the next year as the government begins a wide-ranging push to start paying health care providers based on the quality of care they provide.

With nearly one in five Medicare patients returning to the hospital within a month of discharge, the government considers re-admissions a prime symptom of an overly expensive and uncoordinated health system. Hospitals have had little financial incentive to ensure patients get the care they need once they leave, and in fact they benefit financially when patients don’t recover and return for more treatment.

Nearly 2 million Medicare beneficiaries are readmitted within 30 days of release each year, costing Medicare $17.5 billion in additional hospital bills. The national average readmission rate has remained steady at around 19 percent for several years, even as many hospitals have worked harder to lower theirs."
(penalty rate up to 1%) x (total Medicare reimbursement/yr) = lost revenue

Readmission Factors
non compliant with medications. - This does not exclude whether or not the Pt's could or couldn't purchase the medications.
lack of knowledge: How to use therapy devices, or medical services.
inadequate knowledge of medications- either the importance, the combination of, or duration.
unable to self manage care- Nursing education is strongly lacking in this area.
have no follow up visit with Physician- Is the DC f/u recommendation charted, has the pt. been followed up with?
develop infection post discharge- PICC line infection, Suture infections, ect..

Rates of readmits will be reduced in the facility.
Patient satisfaction improvement.
Increase in quality of care.
Health promotion.
Patient education on their health and discharge plan.

Robert Wood Johnson Hospital in New Jersey
1. Identify high risk patients by conducting a high risk assessment (based on a worksheet the facility would put together according to the type of patients they are caring for).

2. Enhance communication with patients regarding their discharge. This should be a multidisciplinary approach.

3. Improve patient teaching, which will improve discharge experience. Utilizing a demonstration approach and making patient education interactive for a more positive learning and discharge experience.

4. Upgrade medication management (Medication Reconciliation, pharmaceuticals). Some of this is part of the teaching portion.

5. Ensure a follow up appointment post discharge. This will reduce post complication of hospitalization and ensure that care and teaching has been effective.

6. Post-discharge follow up
Project RED – What is it?
• Improves the discharge process to
assist patients to more safely care for
themselves at home and to prevent
readmissions
Three Key Components:
-Discharge Advocate educates hospital patient
-Give "After Hospital Care Plan" to patient and PCP
-Pharmacist calls patients 2-4 days post discharge
The Project RED intervention starts within 24 hours of the patient’s admission to the hospital and continues daily until completion of the post-discharge telephone follow up call to the patient


Project RED – Does it work?

The RED process delivered by a nurse using
the AHCP (After Hospital Care Plan) tool
compared with usual care showed:
– 30% lower rate of hospital utilization in the
intervention group within 30 days of discharge

– One readmission or emergency department visit
was prevented for every 7.3 subjects

– Average savings of $412 per patient

EXAMPLE...


Project RED
Continuing Budgets...
$25,225



Let's say...
Heart failure care cost (per case):
If you have 25 HF Readmissions cases.

2013 Fiscal year = $630,625
Hiring a Heart Failure Transition Nurse, these readmission rates could be lowered and quality of care could improve!
Wage & Benefits for "Heart Failure Transition Nurse" =$75,083
In cost alone, excluding readmission fines...
$630,625 - $75,083= $555,542
Program Savings =$555,542


Article: "The clock is ticking on readmission penalties"
Author: Mark Aspenson and Sunil Hazceray
July 2012

Summary: The following article talks about the areas that hospitals need to focus on where poor performance is contributing to high numbers of Medicare re-admissions: 1) execution of the discharge plans 2) patient education and 3) coordination of post discharge care. The article states different points why patients end up not following up with their primary doctor and end up back in the hospital. It discusses interventions and different models that we can implement to decrease the number of re-admissions.


Thirty Day Re-admission Rates as a Measure of Quality: Causes of Re-admission After Orthopedic Surgeries and Accuracy of Administrative Data
Author: Richard McCormack, MD, chief resident. New York (N.Y.) University Hospital for Joint Diseases; Ryan Michels, medical student. New York University School of Medicine; Nicholas Ramos, medical student. New York University School of Medicine; Lorraine Hutzler, quality project manager. New York University Hospital for Joint Diseases; James D. Slover, MD, assistant professor. New York University Hospital for Joint Diseases; and Joseph A. Bosco, MD, associate professor. New York University Hospital
for Joint Diseases
January/February 2013

The rate of unplanned 30-day readmissions to the hospital after discharge is being used as a marker to compare the quality of care across hospitals and to set reimbursement levels for care.
The purpose of the study the article discusses was to review re-admissions of a single orthopedic hospital to identify the causes for readmission and determine which re-admissions were planned versus unplanned.
Using that hospital's administrative database of patient records from 2007 to 2009, the study identified that all patients who were readmitted to the hospital within 30 days of a previous hospitalization for a procedure. Re-admissions were broadly categorized as planned (a staged or rescheduled procedure or a direct transfer) or unplanned. Unplanned re-admissions were defined as either surgical or nonsurgical complications (medical conditions not directly related to the procedure). Almost 30 percent of re-admissions were planned. Of the unplanned re-admissions, close to 60 percent were triggered by an infection or a concern for an infection. Nonsurgical complications accounted for 18.2 percent of unplanned re-admissions.
The study highlights the importance of careful data collection and abstraction when calculating early readmission rates. Preventing surgical site infection and better coordinating care between orthopedic surgeons and primary care and medical sub-specialty physicians may significantly reduce readmission rates.

Project RED: Principles of the Newly

1) Explicit delineation of roles and responsibilities

2) Discharge process initiation upon admission

3) Patient education throughout hospitalization

4) Timely accurate information flow:

From PCP - Among Hospital team -Back to PCP

5) Complete pt. discharge summary prior to discharge

6) Comprehensive written discharge plan given to pt. prior to discharge

7) Discharge information in pts. language and literacy level

8) Reinforcement of plan with patient after discharge

9) Availability of case management staff outside of limited daytime hours

10) Continuous quality improvement of discharge processes
Re-Engineered Hospital Discharge
Project RED Discharge Checklist


1. Medication reconciliation

2. Reconcile discharge plan with national guidelines

3. Follow-up appointments

4. Outstanding tests

5. Post-discharge services

6. Written discharge plan

7. What to do if problem arises

8. Patient education

9. Assess patient understanding

10. Discharge summary sent to PCP

11. Telephone reinforcement

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