Healthcare programs and policies form the basis of effective care provision for healthcare organizations and providers. Imperatively, assessing a healthcare program is a valuable tool that helps to strengthen its implementation and attainment of set goals. The assessment also ensures that such programs improve outcomes for the targeted populations. As a core part of healthcare provision, nurses play a critical role in evaluating the programs or policies to ensure that they meet patients’ and health population’s needs. Nurses bring insight and expertise based on their clinical experience as they interact with patients and health populations that benefit from such programs. The purpose of this paper is to evaluate the Centers for Medicare and Medicaid Services’ (CMS) hospital readmission reduction program (HRRP).
| Healthcare Program/Policy Evaluation | Hospital Readmission Reduction Program (HRRP) by the Centers for Medicare and Medicaid Services (CMS)
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| Description | At the core of the Hospital Readmission Reduction Program (HRRP) by the Centers for Medicare and Medicaid Services (CMS) is to lower the number of readmissions that facilities can have within 30 days after discharging patients. The CMS launched the program in 2012 with the aim of improving the healthcare provider’s quality of care to incentivize reimbursement. According to the American Hospital (AHA), the CMS penalizes hospitals when they have “excess” readmissions when they compare them to the expected numbers. Additionally, Figueroa et al. (2022) assert that the overall aim of the HRRP was to encourage hospitals in developing effective policies to enhance their discharge planning, care transitions and coordination of care after discharge to reduce the increased cost burden for patients and their families Under HRRP, the CMS tracks readmission of patients admitted for certain conditions that include heart attack, heart failure, chronic obstructive pulmonary disease (COPD) and pneumonia as well as elective hip and knee replacement.
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| How was the success of the program or policy measured?
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The success of this policy is critical to ensuring that patients get quality and safe healthcare services. Studies and reports have measured the success of the program by reporting on changes in the readmission rates and the amount in penalties that facilities have been fined for not complying with the provisions. The program’s success entails looking at the reduction in readmissions and improvement of quality for patients with the targeted conditions. The American Hospital Association (AHA) asserts that since its inception hospitals have prevented over 565,000 readmissions. Several studies have demonstrated that many patients have not had to get readmitted due to effective discharge planning and care provision |
| How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?
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The HRRP initially targeted individuals with three chronic conditions that include COPD, pneumonia, and heart failure. However, the program expanded to reach more people with other conditions like heart attack and elective hip and knee replacement. As such, a majority of Medicare patients have benefited from this program. In their study, Ibrahim et al. (2018) explores the effects of HRRP on readmissions in surgical settings among Medicare beneficiaries. The study show that HRRP is an effective program that has had significant impacts on quality of care and better patient outcomes. Gai et a; (2019) opine that the program has developed the right incentives for facilities to reduce readmissions not just for the targeted population but also for others leading to significant societal benefits. The impact of HRRP is substantial with reduced costs of care and better quality services for patients. |
| At what point in program implementation was the program or policy evaluation conducted? | The evaluation of the program is continuously and happened after its effective roll out by the CMS. The policy was evaluated after about 1 year of implementation to determine its effectiveness. The evaluation occurs each year and where there is a need for better information at any time, the evaluation of the policy happens to meet stakeholders’ needs. |
| What data was used to conduct the program or policy evaluation?
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