The Center of Medicare and Medicaid Services (CMS) is in charge of all affairs concerning the Medicare and Medicaid programs in the United States. In determining the quality of performance by hospitals, the board collects data from these hospitals and publicly reports the risk-standardized readmission rates (RSRRs). It is widely appreciated among health stakeholders that the data obtained by analyzing readmission rates serves as an indicator of quality of health care provided. The National Quality Forum has actually approved the use of this method to determine the performance by the hospitals. The data obtained from such surveys has also been used in policy formulation with significant interventions being employed to reverse or improve the situation in areas of target. Heart failure is one of the most common diagnostic elements in Medicare beneficiaries. Different hospitals record wide ranging rates of readmission in America depending on the quality of services provided. The CMS has over the years used intervention measures such as improving post discharge care through managed follow-ups and educational approaches.3
It is estimated that up to 20% of Medicare hospital bills are used to cater for re-hospitalization cases. Heart failure constitutes the highest proportion of these cases. The vulnerability of these patients following discharge is associated with post discharge therapies which may markedly differ from the ones used in hospitals.it is therefore vital that the physicians in charge carry a follow upon the patients to reduce cases of readmission.2 Over the last few years, remarkable progress has been made in reducing the rates of readmission in hospitals partially due to advancement in the medical care provided particularly to heart failure patients. The use of drugs such as aldosterone antagonists and other modern therapies have reduced the readmission chances as they provide the appropriate post discharge therapy sustainable for months or years.1
According to a survey carried out by Ross Joseph, et al and published in the journal of American Heart Association, it was deduced that among the heart failure patients who were beneficiaries of the fee-for-service Medicare, no significant changes in readmission rates were noted between 2004 and 2006. To conclusively assess this data, comparative studies need to be carried out with other programs that do not use the fee-for-service payment structure. The current CMS policy focuses more on volume as opposed to quality of outcomes. The structure of the payment policy is more of an economic inducement to the health care providers so as to increase intensity and patient volume with an aim to raise more income. The CMS payments should instead be aimed at improving services that would in turn reduce the readmission rates. Efforts have been made of late to improve the CMS payment policy. The most recent has been the recommendation to realign the financial incentive and enhance collaborative approaches among health care providers such as hospitals and the individual physicians. This would greatly improve the quality of care with the associated drop in readmission rates.3
The public reporting of readmission rates of hospitals by the CMS is not only beneficial in policy development but helps in identifying the hospitals that are providing higher quality services than others. These can then be used as benchmarks to improve performance in the lower performing hospitals. The patient is also informed on where to receive higher quality medical attention to improve their chances of recovering.3
In another observational study done by Bueno Hector, et al and published in the journal of American Medical Association (2010), it was found that increased use of quality nursing facilities following discharge of Medicare beneficiaries with heart failure resulted in a drop in mortality rates but an increase in readmission rates. This indicates that the improvement is below the rates indicated by in-hospital related mortality; therefore although patients’ outcomes have relatively improved over the years, not all areas have registered positive progress.1
The Medicare fee-for-service plan consists of an incentive that encourages shortening the length of hospitalization. Any unfavorable outcomes occurring post discharge including high readmission rates are not penalized. This inducement has had remarkable impact on reducing hospitalization duration in almost all hospitals across America. The CMS projected to cut down on medical costs through this incentive but as it seems when post discharge expenses are incorporated, the medical bills remain relatively the same. The policy therefore can not be said to be effective and more elaborate efforts to reduce readmission rates as well as costs of medical care should be pursued.1
In yet another study carried out by Hernandez Adrian, et al and published in Journal of American Medical Association (2010), titled “Relationship between Early Physician Follow-up and 30-Day Readmission among Medicare Beneficiaries Hospitalized for Heart Failure”, it was deduced that despite the risks associated with heart failure cases after discharge, a high proportion of the patients discharged did not get readmitted within the first week of discharge. The study observed the effectiveness of transitional care as a model to coordinate health care in different sites. This type of care entails communication across physicians with an aim to providing a clear guideline on patient care while in the hospital and immediately after discharge. The study identified the need to improve the area of coordinating the patient care both in inpatient and outpatient environments with emphasis on patient evaluation following discharge.2
It is important that the CMS address the myriad barriers that face the provision of care to patients under the Medicare and Medicaid programs. These barriers include ineffective coordination of primary health care which results in over extension of this care, poor record keeping which should be addressed by networked computer systems as well as modifying the financial incentive program. From the study, it was clearly evident that making follow ups immediately after discharge helped in identifying any necessary adjustments to the treatment regimen. The study actually indicated a significant drop in readmission rates of up to 15% even among high risk heart failure patients who received the necessary post discharge care within the first 30 days.2
The three articles reviewed point to the challenges facing the Medicare and Medicaid beneficiaries under the CMS policies. With heart failure being the most common among these patients, it is important that the necessary care be sought and provided by the health care providers. The CMS publication of readmission rates is not adequate to solve the underlying problem of high mortality rates and increased readmission in hospitals. Instead the body should focus on formulating necessary policies that will improve the performance of hospitals with an aim to reduce the readmission rates particularly among the heart failure patients. The financial incentives provided by the CMS under the fee-for-service plan should no longer be tied to volumes of patients served by the health centers but rather the quality of health care provided. This will in the long run transform the hospitals ‘performance and reduce the rates of patient readmission.
Our Service Charter
Excellent Quality / 100% Plagiarism-FreeWe employ a number of measures to ensure top quality essays. The papers go through a system of quality control prior to delivery. We run plagiarism checks on each paper to ensure that they will be 100% plagiarism-free. So, only clean copies hit customers’ emails. We also never resell the papers completed by our writers. So, once it is checked using a plagiarism checker, the paper will be unique. Speaking of the academic writing standards, we will stick to the assignment brief given by the customer and assign the perfect writer. By saying “the perfect writer” we mean the one having an academic degree in the customer’s study field and positive feedback from other customers.
Free RevisionsWe keep the quality bar of all papers high. But in case you need some extra brilliance to the paper, here’s what to do. First of all, you can choose a top writer. It means that we will assign an expert with a degree in your subject. And secondly, you can rely on our editing services. Our editors will revise your papers, checking whether or not they comply with high standards of academic writing. In addition, editing entails adjusting content if it’s off the topic, adding more sources, refining the language style, and making sure the referencing style is followed.
Confidentiality / 100% No DisclosureWe make sure that clients’ personal data remains confidential and is not exploited for any purposes beyond those related to our services. We only ask you to provide us with the information that is required to produce the paper according to your writing needs. Please note that the payment info is protected as well. Feel free to refer to the support team for more information about our payment methods. The fact that you used our service is kept secret due to the advanced security standards. So, you can be sure that no one will find out that you got a paper from our writing service.
Money Back GuaranteeIf the writer doesn’t address all the questions on your assignment brief or the delivered paper appears to be off the topic, you can ask for a refund. Or, if it is applicable, you can opt in for free revision within 14-30 days, depending on your paper’s length. The revision or refund request should be sent within 14 days after delivery. The customer gets 100% money-back in case they haven't downloaded the paper. All approved refunds will be returned to the customer’s credit card or Bonus Balance in a form of store credit. Take a note that we will send an extra compensation if the customers goes with a store credit.
24/7 Customer SupportWe have a support team working 24/7 ready to give your issue concerning the order their immediate attention. If you have any questions about the ordering process, communication with the writer, payment options, feel free to join live chat. Be sure to get a fast response. They can also give you the exact price quote, taking into account the timing, desired academic level of the paper, and the number of pages.