Title IIi And The Hospital Readmissions Reduction Program Essay

Title IIi And The Hospital Readmissions Reduction Program Essay

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Title III and the Hospital Readmissions Reduction Program

Title III of the Affordable Care Act establishes sections that focus on the improvement of the quality of healthcare, in an effort to transition it towards a more patient centered, effective and efficient. In an effort to improve the quality of healthcare, Title III identified areas for improvement, which include incorporation of value based reimbursement, quality reporting and research, enhancement of primary care and finally taking a more detailed approach at rural care. In an attempt to improve quality of patient care and reduce costs, policy makers expanded on Title III’s section on hospital readmissions through the creations of Medicare’s Hospital Readmissions Reduction Program (HRRP) (James, 2013). Under this policy, when a hospital exceeds the national average of hospital readmission rates, they are penalized by a reduction in Medicare payment on all Medicare admissions, not just those that were readmitted (Boccuti & Casillas, 2015). The greater the excess rate, the higher the penalty which is then listed annually in the Federal Register which is posted on the Medicare website (Boccuti & Casillas, 2015). In 2013, the maximum penalty was 1% and CMS penalized 64% of the hospitals, of which 8% received the maximum penalty, which resulted in $290 million of total penalties. By 2014, the maximum penalty was increased to 2%. CMS penalized 66% of the hospitals, however those receiving the maximum penalty decreased to 0.6%. By 2015, the maximum penalty was increased to 3% (Boccuti & Casillas, 2015). In order to avoid these penalties, healthcare leaders must recognize that CMS has identified a correlation between readmissions and a lack of quality care. Therefore, ...

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... and home. However, resources are limited and under scrutiny for distribution. Not all patients qualify for assistance, yet remain unable to care for themselves. These patients inevitably return to the hospital. Again, this return is due to factors outside of the hospital’s control, not a lack of quality care.
Issue Statement
Under the HRRP, specified criteria will determine if the Medicare readmission is avoidable. If avoidable, a penalty will be applied towards that hospital. If unavoidable, no penalty will be applied.
Policy Goals and Objectives
Hospitals will implement transitional care program to prevent hospital readmission.
Patients will be better informed of plan of care, post discharge, thus will not require readmission to hospital.
Preventable Medicare readmissions will decrease.
Hospitals will not be penalized for unavoidable Medicare readmissions.

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