Medicare’s readmission penalties Discussion
Medicare’s readmission penalties DiscussionMedicare’s readmission penalties
DiscussionCO 5: Apply improvement methods, based on data from the outcomes of care
processes, to design and test changes to continuously improve the quality and safety of
healthcare. (PO 8)The AssignmentReview the story at the link below before posting to the
discussion:Rau, J. (2015). Half of nation’s hospitals fail again to escape Medicare’s
readmission penalties. Kaiser Health News. Retrieved from http://khn.org/news/half-of-
nations-hospitals-fail-again-to-escape-medicares-readmission-penalties/ (Links to an
external site.)Links to an external site.After you have finished, consider how you would
respond to the following situation:Your local hospital has received notice from CMS
(Centers for Medicare and Medicaid) regarding their readmission rates.As a BSN prepared
nurse, you have been asked to serve as a consultant to suggest a new Quality (Performance)
Improvement process for ONE of the areas of deficiency. Write some brief steps
(suggestions) for improvement as you contemplate accepting the consulting
opportunity.Share practice improvements utilized from your own clinical nursing
experiences that have led to enhanced patient outcomes.Patient outcomes are a direct
result of quality care. What would be your primer for one area of improvement that data
has presented as an opportunity? What national benchmark are you comparing your
benchmark to?ORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSExampleI have
been asked, as a BSN prepared nurse to evaluate and promote a quality performance
improvement plan process for patient readmissions involving those patients with
congestive heart failure, CHF (Rau, 2015). The first step is to review the pharmacy
medication reconciliation to ensure the medications prescribed reflect the core measures
for the type of CHF the patient has. Patients with systolic dysfunction with an ejection
fraction less than 40%, require an angiotensin receptor blocker. Other targeted measures
require some patients to take a beta blocker (American Heart Association, 2013). The
diagnosis of hypertension needs to be addressed. If present, an ACEI or ARB, beta blocker,
and hydralize should be on the medication list. In addition to cardiac medications, an
evaluation of diuretics such as Lasix needs to be evaluated with consideration of the dose
and if a dose increase is warranted. The second step requires a recent echocardiogram
within the last six months to be on the record, if there is not, then one needs to be done
during the concurrent hospitalization. During the hospitalization, DVT prophylaxis needs to
be given, as many patients with CHF are non-ambulatory (American Heart Association,
2013). Medicare’s readmission penalties DiscussionThe reason for hospital readmission

needs to be evaluated, such as an acute on chronic episode of systolic, diastolic or combined
systolic and diastolic heart failure needs to be known. Has the patient been compliant with
mediation, sodium intake, and daily weight? Follow-up physician appointments with a
reminder and resources available for the patient to get to and from appointments are other
considerations. The last item to review is those patients requiring a CPAP at night or
oxygen. Does the patient have a working machine and enough oxygen on hand? These are
all items that can be tracked in order to prevent readmission in less than 30 days. Upon
discharge, information on the heart failure clinic needs to be reviewed with both the patient
and family member. The heart failure clinic has additional resources available such as a
customized management plan for home, a calendar to record daily weight and symptoms,
bathroom scale, sodium tracker, and if needed a pill organizer.Clinical experience that can
be drawn from my current nursing role as a clinical documentation specialist, CDS includes
the identification of a specific diagnosis. An abundant number of patients are admitted with
CHF, but further clarification is required if the physician simply documents the reason for
admission is CHF. The acuity comes first. The difference between acute and chronic or acute
on chronic is mediation, lab values, and patient presentation. Symptoms such as a BNP over
100, increased shortness of breath, increased edema, lung sounds with crackles, orthopnea
and an increase in diuretic dosage especially if the change is from oral to intravenous
requires clarification if the patients are having an acute exacerbation. Next includes the
identification of the type of heart failure such as systolic or diastolic CHF. Systolic heart
failure includes patients with a reduced EF, while diastolic CHF are those with a preserved
EF and diastolic dysfunction. There are also patients that have both diastolic dysfunction
and a reduced EF. Identification of the type of heart failure is paramount, as treatment and
medication choices can differ.ReferencesAmerican Heart Association. (2013). Get with the
guidelines heart failure. Retrieved from http://www.heart.org/idc/groups/heart-
public/@private/@wcm/@hcm/@gwtg/documents/downloadable/ucm_310967.pdf
(Links to an external site.)Links to an external site.Finkelman, A. (2016). Leadership and
management for nurses: Core Competencies for quality care (3rd ed.). Boston, MA:
Pearson.Licking Memorial Health. (2018). LMH heart failure clinic services. Retrieved from
https://www.lmhealth.org/Services-Facilities/Hospital-Services/Heart-Care (Links to an
external site.)Links to an external site.Rau, J. (2015). Half of nation’s hospitals fail again to
escape Medicare’s readmission penalties. Kaiser Health News. Retrieved from
https://khn.org/news/half-of-nations-hospitals-fail-again-to-escape-medicares-
readmission-penalties/ (Links to an external site.)Links to an external site.