D029step2
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School
Western Governors University *
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Course
28
Subject
Health Science
Date
Jan 9, 2024
Type
docx
Pages
2
Uploaded by ChancellorTeam13183
Summary of CMS HRRP
The Hospital Reduction Program encourages hospitals to improve discharge coordination to reduce readmissions. There are six conditions/procedures that are included in the 30-day risk-
standardized readmission program which include the following: Acute myocardial infarction, COPD, heart failure, pneumonia, coronary artery bypass graft surgery and total hip or knew surgery. CMS calculates the payment reduction based on the hospital performance. Hospitals have 30 days to review the data and submit questions. The patient that I selected is Marcia. She is a 63-year-old female. She is being discharged from the hospital after being admitted for 4 days with COPD. She was instructed to make an appointment with Pulmonary rehabilitation. Marcia does not have a follow-up appointment with her primary care physician. Marcia’s past medical history include Obesity, hypertension, total hysterectomy, and osteopenia. As far as education she has a high school diploma. She lives in a urban area, in a low income apartment that is poorly maintained. She lives a sedentary lifestyle, smokes and does not eat healthy. She is not married, and her three children live within 45 minutes. Marcia is at high risk for LA cancer and CHF because of her family history. Marcia is i
financially insecure and may have difficulty getting to appoint due to her lack of transportation. Below is my proposed care Transition Plan for Marcia: o
Making an appointment with her primary care doctor before discharge o
Making an appointment with Pulmonology o
Ensuring Marcia has transportation to her follow-up appointments
o
Educating her on balanced diet o
Signing up for a smoking caseation program
o
Finding resources/programs that deliver fresh foods
o
Ensuring Marcia has a way to get her medication
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