The Affordable Care Act (ACA) has new financial incentives and penalties. This is done in order to improve the health care system, mainly hospitals, performance in the country. The new mandate has been proven to be hard to manage and has encountered several problems. However, it provides new opportunities for leaders to have a good collaboration with different health care providers.
Medicare’s Hospital Readmissions Reduction Program or the (HRRP) penalizes hospitals that allow patients to have excess 30-day readmissions specifically for health conditions like myocardial, pneumonia, and heart failure. The program was intended to punish hospitals with surplus 30-day readmissions not considering whether the patient was readmitted to the same hospital or to another hospital.
Actually, the penalty itself is not that substantial or damaging to the hospital’s income. What makes it more significant is its effect on the image of the hospital. The penalty data of each hospital is open for public viewing every year, so they know what hospital has been paying a lot of penalties recently. This could affect the number of patients that will choose that hospital. If the hospital is located in a very competitive location, having a high penalty rating could greatly affect them.
The program has forced hospital leaders to develop, filter, assess, and implement care management programs in different areas. It is essential to use the information technology for data incorporation. Evidence-based decision-making is also important to make the services more effective and fast as soon as the patient was admitted. It is also crucial to the development and rapid-cycle learning. Hospital leaders as well as their management must be aware of the changes in the rules. They now need better collaboration with other health care institutions to be more effective in terms of the services they offer to patients. Keeping the patients from readmission to the hospital due to their total wellness and recovery is a very good sign for the hospital’s development.
Nursing home residents are regularly put in the hospital. Residents who have recently been admitted from the medical center are regularly rehospitalized. Many of these hospitalizations, which “can cause pain for residents, anxiety for their loved ones, morbidity due to iatrogenic events and excess medical care expenses,” are considered preventable. The National Healthcare Quality Report found that residents’ hospital stay rates for possibly preventable conditions improved between 2000 and 2007.
The expenses of preventable hospitalizations are enormous. In April 2010, the Medicare Payment Advisory Commission (MedPAC) revealed that in 2005, “potentially preventable readmissions cost the [Medicare] program more than $12 billion” and that “In 2007, more than 18 percent of SNF stays led to a possibly preventable readmission to a medical center.” Residents’ use of medical centers is expensive for the Medicare program, may create additional medical care problems for sufferers and is often seen as showing poor health care quality, both in the medical center (which may release sufferers too soon, often without adequate release planning) and in the nursing facility (which may have been unable to provide needed care). Reducing hospitalizations and rehospitalizations could save Medicare insurance dollars while improving high quality of care for recipients.
The Patient Protection and Affordable Care Act, the health care reform law details these issues through a variety of payment systems. Section 3025, the Hospital Readmissions Reduction Program, reduces a hospital’s compensation if the patient is rehospitalized within a time frame specified by the Assistant, such as 30 days of release. Unfortunately, supporters, including the Center for Medicare Advocacy, are concerned that section 3025 may result in improved use of observation status, a status that recognizes the hospital sufferers as “outpatients.” In addition to the changes in Section 3025, Section 3023 of the ACA allows a pilot program that provides a single payment for an episode of both serious and post-acute care. While payment systems may help decrease unsuitable unexpected hospitalizations, they do not address the factors why nursing homes hospitalize their residents. Understanding the factors behind unsuitable hospitalizations of nursing home residents should help policymakers as they work to implement the ACA and to decrease hospitalizations.