The clock is ticking on readmission penalties
Avery Telehealth, Scottsdale, Ariz., USA.Healthcare financial management: journal of the Healthcare Financial Management Association 07/2012; 66(7):58-63.
Hospital leaders who are considering initiatives to reduce readmissions by improving discharge processes and postdischarge care should begin with five action steps: Ascertain the hospital's Medicare 30-day readmission rates from July 1, 2011, to June 30, 2012. Based on these numbers, estimate the potential readmission penalties the organization may face. Identify a clear strategy or program for the organization to reduce 30-day readmissions and avoid Medicare penalties. Determine the overall direct and indirect costs of this strategy or program. Calculate the potential ROI of the initiative.
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ABSTRACT: This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology. Inpatient acute care hospital. A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge.
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ABSTRACT: We consider how alternative intensive care unit (ICU) cost reimbursement policies impact an ICU’s ability to satisfy the triple bottom line (TBL) of sustainability. Towards this end, we develop a discrete event simulation model of an ICU and use simulation optimization to identify ‘near-optimal’ ICU cost reimbursement policies, staffing levels, and sizes (number of beds) that allow investors to reap profits while still respecting the TBL of sustainability. The studied ICU is reimbursed based on either (1) the total time patients spend in the ICU or (2) the total time medical doctors spend treating patients. Results show that reimbursement Policy 1 generates higher profits but is associated with socially and environmentally unsustainable outcomes including high numbers of early patient discharges and readmissions and a large ICU size. Reimbursement Policy 2, on the other hand, respects the TBL of sustainability to a much greater degree while still yielding a healthy profit.
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