The Dickson Advanced Analytics (DA²) launched four pilot programs for the Carolinas HealthCare System (CHS) hospitals with the goals of predicting the health needs of the population they were serving, enhancing patient outcomes, and pushing for transformative solutions that dealt with pressing community health issues (Quelch & Rodriguez, 2015). Of the four pilot programs created (which also includes mapping underserved areas, advance illness management, and patient segmentation), I believe the launching of the Readmission Predictive Risk model has the most value potential for the CHS hospitals not only because it can prevent the chances of patient readmission after discharge but also impact the quality of care given to their patients and avoid
In Camden, New Jersey, Dr. Jeffrey Brenner is pioneering efforts to improve healthcare delivery through medical “hotspotting” (Doctor Hotspot, 2011), the geographical mapping of patient healthcare costs using computational statistics (Gawande, 2011). Medical hotspotting enables communities to identify residents receiving the worst health care by identifying hotspots of high medical costs and frequent emergency room visits (Gawande, 2011). As with all macro level change, Dr. Brenner pursued his goal of improving health care through a process of planning. His process closely follows the IMAGINE Model outlined by Kirst-Ashman and Hull (2012).
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Under the Social Security Act, it is required that hospitals report quality measures for a set of 10 indicators. If hospitals do not report quality measures to CMS there is a reduction in payments. In the hospital readmission area of investigation, OIG reviews Medicare claims in hospital readmission cases to identify trends and oversights of cases. Readmissions are cases in which the beneficiary is readmitted to the hospital less than 31 days after being discharged from the hospital. Hospitals are only entitled to one diagnosed-related group payment if there is a same-day readmission for symptoms related to prior hospital stay. Quality improvement organizations are required to review hospital readmission cases also this is to see if standard of care are met. For coded conditions as present on admission, it is required for acute hospital to report these diagnoses on Medicare claims. The OIG will review Medicare claims for types of facility or providers most frequently transferring patients to hospital
There is limited data on predictors of discharge and readmission for hospital inpatients. According to Rothman, Rothman, & (), “Unplanned hospital admissions are a major quality and cost issue in the US healthcare system”. About 20% of Medicare patients are readmitted to the hospital within 30 days, at an estimated cost of $17 billion per year (). Now that Medicare has begun to reduce payment to hospitals with high readmission rates, hospitals are looking for more effective ways of reducing readmissions. In order to develop new systems to address these concerns, there must be evidence in place to support to their use.
In America millions of offenders including men and women leave imprisonment in hope to return to their family and friends. On an article Prisoners and Reentry: Facts and Figures by The Annie E. Casey Foundation, in the year 2001 1.5 million children were reunited with their parents as they were released from prison. Also in 2005 the number of that passed prison gates were 698,499 and the number of prisoners that were released was approximated at about 9 million. Parole and Prison reentry has been a topic that really interests not only a lot of the communities around the world but is a topic that interest me. Recidivism is not only the topic that interests people but the offenders that get off on parole and how they cope with society after they
The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to transform large amounts of data into easy to read and understandable tool to be used for reporting as well as to determine areas in need of improvement. By looking at a sample dashboard for an inpatient rehab unit a greater understanding of dashboards and their benefits can be seen. The sample dashboard includes four general areas, including nurse sensitive service line/unit specific indicators, general indicators, patient satisfaction survey indicators and NDNQI data. The overall performance was found to improve over time. There were areas with greater improvement such as length of stay, than others including RN care hours and pressure ulcers. The areas of pressure ulcers and falls did worse the final quarter and can be grouped under the general heading of patient centered nursing care. The area of patient satisfaction saw a steady improvement over the first three quarters only to report the worst numbers the final quarter. A facility then takes the data gathered and uses it to form nursing plan...
Unfortunately, the quality of health care in America is flawed. Information technology (IT) offers the potential to address the industry’s most pressing dilemmas: care fragmentation, medical errors, and rising costs. The leading example of this is the electronic health record (EHR). An EHR, as explained by HealthIT.gov (n.d.), is a digital version of a patient’s paper chart. It includes, but is not limited to, medical history, diagnoses, medications, and treatment plans. The EHR, then, serves as a resource that aids clinicians in decision-making by providing comprehensive patient information.
Jencks, S., Williams, M., & Coleman, E. (2009). Rehospitalizations among Patients in the Medicare Fee-for-Service Program. New England Journal of Medicine, 1418-1428. Retrieved November 12, 2014.
Readmissions has become a spotlight in the healthcare world. “The problem of readmissions to the hospital is receiving increased attention as a potential way to address problems in quality of care, cost of care and care transitions. Interventions are underway to reduce hospital readmissions at the state and national level” (Elixhauser & Steiner, 2010). “Approximately 20% of Medicare beneficiaries are readmitted within 30 days of discharge and these readmissions have been estimated to cost the American public > $15 billion per year. The Patient Protection Affordable Care Ace of 2010 has created new incentives to reduce admissions using the publicly reported measures because hospitals with high readmission rates can lose
Given the fact that one-third of all healthcare expenditures is for ambulatory care, it is safe to say that patients spend most of their time in an ambulatory care setting (Carper, 2013). This setting has a significant impact in the overall assessment of the healthcare industry and how care is delivered. It is important to address data collected by surveys to implement strategies for quality improvement. Affecting care in Ambulatory settings will have the largest significance in the health outlook.
The first contact between an officer and a probationer is when an officer estimates a probationer’s risk. This is deterring if re-offending of a crime in the presentence investigation report. The report informs the type of supervision the probationers, receives. Certain disorders in its self are a fragile predictor of recidivism compared to factors such as substance abuse such as mental disorder (Trotter). One example is substance abuse it is one of the eight risk factors for general recidivism, and was found to have a mean effect on general recidivism compared to a negative effect on mental disorders. Officers mistakenly believe that many disorders are a forceful risk factor and rate probationers with mental disorder as high-risk. Even agencies uses a structured risk measurement to assessment probationers’ risk, officers may look away from ratings risk that disagree with their perceptions to rate the probationer’s.
This system provides annual statics on Medicare payment amounts for institutional providers. A nurse leader can use HCRIS to find other similar institutions with whom to compare reimbursement rates and use this information to make necessary adjustments (“Healthcare Cost Report”, 2016). Lastly, nurse leaders can also use cost-to-charge ratios, volume-based measures, per diem rates, and balanced scorecards to gain better insight of unit reimbursement (Liberty University,
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
With the substantial increase in prison population and various changes that plague correctional institutions, government agencies are finding that what was once considered a difficult task to provide educational programs, inmate security and rehabilitation programs are now impossible to accomplish. From state to state each correctional organization is coupled with financial problems that have depleted the resources to assist in providing the quality of care in which the judicial system demands from these state and federal prisons. Judges, victims, and prosecuting attorneys entrust that once an offender is turned over to the correctional system, that the offender will receive the punishment in which was imposed by the court, be given services that aid in the rehabilitation to those offenders that one day will be released back into society, and to act as a deterrent to other criminals contemplating criminal acts that could result in their incarceration. Has our nations correctional system finally reached it’s critical collapse, and as a result placed or American citizens in harm’s way to what could result in a plethora of early releases of inmates to reduce the large prison populations in which independent facilities are no longer able to manage? Could these problems ultimately result in a drastic increase in person and property crimes in which even our own law enforcement be ineffective in controlling these colossal increases of crime against society?
Hospitals, long term care facilities, and mental health all serve as healthcare arenas serving the population in various ways. The hospital provides the most critical type of care, for the seriously ill. Hospitals originally served the poor and ill, but over time with the progression of technology and medical service specialties, they have grown to become healthcare meccas with many outlets. Over the past 30 years the degree of rigor of clinical practice and the scope of scientific knowledge has escalated greatly, and the hospital has become a center of high standards, scientific applications, and advanced technological capability (Williams & Torrens, 2008). The increasing shift of services to an ambulatory care arena facilitated by technological advancement itself has left the hospital with an evermore complex base of patient care, higher acuity, and higher costs (Williams & Torrens, 2008). Markets have changed, pricing pressures have increased, and consumer and payer expectations have evolved for hospitals, changes are constant in the medical arena, and hospitals are no exception.