Nurses play an equally important role in program or policy evaluation as in program or policy design. They use their expertise and advocacy skills to influence decisions during program or policy evaluation. The purpose of this assignment is to reflect on the criteria and measures used to evaluate the Hospital Readmissions Reduction Program (HRRP), a component of the Affordable Care Act (ACA).
The HRRP is a component of the ACA developed in 2010 and began in 2012. The goal of the program was to reduce Medicare payments for healthcare facilities with high rates of within 30 days readmission for 6 medical conditions and procedures including “acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and elective primary total hip or knee arthroplasty (Emanuel et al., 2020, p.1).”
The main outcome of the HRRP is that it has resulted in a moderate reduction in readmission rates across hospitals. Additionally, the program did not cause a rise in death rates across the six medical conditions targeted. The success of the HRRP was evaluated by measuring the overall reduction, absolute reduction, and relative reduction in 30-day readmission rates. Although Emanuel et al. (2020) did not indicate the total number of people reached by the HRRP, the data was collected across penalized and non-penalized hospitals. The program caused a moderate impact with the overall, absolute, and relative reductions in 30-day readmission being 3%, 3%, and 17% respectively (Emanuel et al., 2020).
The given evaluation results were obtained in the course of program implementation, HRRP is an ongoing program under the ACA that is still evaluated periodically. The data that was used to conduct program implementation was within 30-day readmission rates among patients diagnosed with one or more of the six medical conditions outlined in the program (Emanuel et al., 2020). An unintended consequence associated with HRRP is evidence of effects caused by medical conditions that are not targeted by the program (Gai & Pachamanova, 2019; Ibrahim et al., 2017). This spill-over primarily occurs with privately insured individuals.
The key stakeholders involved in the evaluation of HRRP are representatives from the Department of Medical Ethics & Health Policy, the Healthcare Transformation Institute at the University of Pennsylvania’s Perelman School of Medicine, and the Solomon Center for Health Law and Policy at Yale Law School (Emanuel et al., 2020). Other stakeholders include hospitals, insurance companies, and patients. Patients would benefit the most from the results of the program evaluation. The reason is that hospitals will use the evaluation results to improve healthcare delivery with the aim of reducing within 30-day readmission of Medicare patients with the 6 medical conditions specified in the program (Gai & Pachamanova, 2019). For example, hospitals can choose to improve follow-up visits for patients who are managing myocardial infarction at home to prevent their readmission within 30 days post-discharge.
Based on the evaluation results, the HRRP has not adequately met its intended objectives. The reason is that only moderate impacts have been realized with possible improvements being anticipated. I would recommend implementing HRRP in my place of work. This is an important initiative because it will not only reduce readmission rates but will also reduce healthcare costs for the hospital and patients and improve patient outcomes (Gai & Pachamanova, 2019). The two ways that a nurse advocate could become involved in evaluating a program or policy after 1 year of implementation include; being a representative from a professional nursing organization and engaging directly with the agencies that are charged with implementation. In conclusion, advocacy skills enable nurses to participate in the evaluation of health policies that have positive impacts on health outcomes.
Emanuel, E. J., Navathe, A. & Zhang, C. (2020). Evaluating the ACA’s delivery system reforms. Health Affairs. https://www.healthaffairs.org/do/10.1377/forefront.20200312.516650/full/
Gai, Y., & Pachamanova, D. (2019). Impact of the Medicare hospital readmissions reduction program on vulnerable populations. BMC Health Services Research, 19, 837. https://doi.org/10.1186/s12913-019-4645-5
Ibrahim, A. M., Nathan, H., Thumma, J. R., & Dimick,
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