Hospital Readmissions

Readmissions in the US Medical System

Hospital readmissions have been a problem to many health institutions. For instance, the Center for Medicare and Medicaid Services realized that readmission increased the cost of treatment. The diagnosis-related group (DRG) payment system encourages premature discharge of patients leading to readmissions. Hospitals discharge patients as early as possible so that the cost of care is below the DRG reimbursement. A discharged patient may not be in a position to heal completely in their home resulting in readmission.

Background

Readmissions, especially in the emergency department, have become a major burden on the US medical system. Part of the problem of readmission steams from Medicare payment system. This system dictates that payment should be made only for a reasonable amount for providing treatment. Amount to be paid by Medicare is determined by diagnosis-related group (DRG), and it accounts for surgeries, co-morbid conditions, and principal diagnosis. Due to the DRG system, hospitals are not reimbursed for the actual cost of care. As a result, they end up discharging patients before they have fully recovered leading to readmissions. Factors that influence readmission can be categorized as socio-demographic, clinical and operation factors. Clinical factors include a type of illness, number of medications, and severity of a disease. The operational factors involve the discharge process, cost of care, healthcare quality, and the availability of healthcare staff.

Significance of the Problem

As according to Herman, readmission added hospitalization cost by $41.3 billion in 2011, with 58% of these expenditures from Medicare patients. Mostly, readmission results from septicemia, congestive heart failure, and pneumonia. Congestive heart failure readmissions were $1.75 billion that resulted from 134, 5000 readmissions. Readmission costs for septicemia $1.41 billion for 92, 900 patients, for pneumonia $1.15 billion accounting for 88, 800 patients within 30 days of the previous admission. The data show that the re-hospitalization costs are so high that strategies to prevent readmission should be implemented.

Problem Statement

Readmission of patients is problematic as it results in increased costs to both patients and hospitals. Readmissions also increase the amount of work for staffs in the healthcare facilities. As a result, it is important to prevent readmissions.

Purpose of the Study

The purpose of the study is to investigate ways in which hospitals can prevent readmission and reduce the cost associated with them. The study will investigate whether financial incentives are effective in preventing readmissions. If hospitals get financial incentives, they will not have to discharge patients before a full recovery. The study will also investigate whether enhanced care and support during transition can help to reduce the readmission rate. Support care in this care includes; improved discharge process, patient monitoring, and home visits. Lastly, the study will investigate whether patient education is important in preventing readmissions.

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Research Question

What practices can reduce hospital readmission and consequently decrease hospitalization costs?

Hypothesis: Research and Null

Research Hypothesis

H1: Enhanced care and support during the transition are effective methods of reducing readmission rates.

H2: Financial incentives are effective in preventing readmissions.

H3: Patient education helps in preventing readmissions.

Null Hypothesis

H0: Enhanced care and support during the transition are not effective in reducing readmission rates.

H0: Financial incentives are not effective in preventing readmissions.

H0: Patient education does not aid in preventing readmissions.

Identifying, Defining, and Operationalization of Study Variables

The independent variables include financial incentives, patient education, and enhanced care and support. The dependent variable, in this case, is the readmission of patients. Financial incentives will be measured regarding the amount of funding provided and how the funds helped to reduce readmission. With regard to patient education, the intelligence of healthcare practices for patients will act as the measurement metric. Enhanced care and support will be assessed by evaluating the types of care and support that hospitals provide to patients.