Ask the Nursing Expert about... rehospitalizations

Angel McGarrity-Davis, RNC, CDONA, CDP, NHA
Angel McGarrity-Davis, RNC, CDONA, CDP, NHA

I heard my new director of nursing talking to some of the nurses saying, we must stop rehospitalizations. I am a new nurse to long-term care — can you please explain this to me? 

This is the fourth year the Centers for Medicare & Medicaid Services has issued hospitals readmission penalties. Overall, they amount to slightly less than last year. This time 2,592 hospitals will receive lower payments for Medicare patients, readmitted or not, as documented by Kaiser Health News.    

The Hospital Readmissions Reduction Program, created by the Affordable Care Act, was started so the hospitals would pay closer attention to ensuring the patients will be successful after discharge, no matter where the patient is sent in the continuum of care. Since the fines began, readmissions rates have dropped, which shows that we are making progress. However, 1 in 5 Medicare patients still return to the hospital within the month. 

Chuck Bongiovanni, author of “The Community Integration Model to Reduce Post-Acute Medicare Spending,” also states that there are more penalties coming for hospitals concerning Medicare beneficiary spending. Hospitals have to find their partners in post-acute care, to assist them in more efficient care transitions. We need high-quality partners working toward the same goals. This is the only way we will decrease re-hospitalizations. 

Providers in the continuum of care need to communicate and educate each other, working on programs together if we are ever going to conquer this. Some clinical programs we should work together on are the following:  acute heart attack, congestive heart failure, pneumonia, chronic lung problems and elective hip and knee replacements, since these are the programs for which CMS began penalties.