HRRP summary
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Western Governors University *
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028
Subject
Medicine
Date
Jan 9, 2024
Type
docx
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4
Uploaded by CaptainStarling1077
Care Transitions for Patient with Heart Failure
HRRP Program
To improve the health of all Americans and ensure hospitals are fulfilling their duty during care
and at discharge, the Social Security Act required that hospitals receive reduced payments for excess
hospital readmissions (CMS, 2023). As a result, the Centers for Medicare & Medicaid Services (CMS)
developed the Hospital Readmissions Reduction Program (HRRP) to outline the goals and performance
measures of hospitals to meet the new reimbursement requirements. CMS outlines that unplanned 30-
day readmission for: acute myocardial infarction, chronic obstructive pulmonary disease, heart failure,
pneumonia, coronary artery bypass graft surgery, and elective total hip or knee arthroplasty results in a
payment reduction. Annually, CMS sends hospitals their reports and they have 30 days to review and
requests calculation corrections for any discrepancies.
Patient Summary
My patient C.S. is a 74-year-old African American female with newly diagnosed heart failure. She
has been admitted in the hospital for 5 days and is planning to transition to an Inpatient Rehabilitation
Facility for 7-10 days before transitioning home. She lives at home alone but does have two daughters
who live in the area. They both work full-time and have kids of their own, so their assistance is limited
but they are willing to help.
Heart Failure
There are many reasons for patients to readmit to the hospital with in 30 days after being
diagnosed with Heart Failure. There are medical reasons, personal reasons, and social reasons for
readmissions. As part of the biopsychosocial model of medicine, all of these must be accounted for and
addressed with patients before discharge (Lehman, David, and Gruber, 2017). One reason for
readmissions is comorbidities. A history of renal disease or diabetes could be exacerbated by a hospital
stay, a recovery at home, or a change in medications which would lead to a readmission within the 30-
day window. Personal reasons could include a lack of understanding of discharge instructions. Often
health care providers do not know their patient’s literacy level and patients are often to embarrassed to
say they don’t understand, which leads to noncompliance and exacerbations of heart failure. Social
reasons could include cost of medications, lack of transportation for follow-up, or lack of funding for
dietary restrictions. Each of these social determinants could lead a patient to require rehospitalization
within 30-days of discharge.
Interventions for C.S.
To help prevent hospital readmission for C.S. all factors from individual, social determinants,
community, system-level, and condition specific complications must be considered. For C.S. an individual
complication is her age and functional status. She is experiencing some weakness and physical limitation
related to her illness and hospitalization which is requiring rehabilitation before discharge home. The
care team must also be sure she has all required durable medical equipment (DME) needed for a safe
transition home. Social considerations will also affect C.S. since she lives on a fixed income. Her fixed
income must be considered when prescribing medications and treatments, as she may not be able to
afford all the medications prescribed and pay for her housing, bills, and food. Her fixed income also
effects the kind of food she buys, as non-processed, low sodium, low calorie food is typically more
expensive. A system level consideration is her insurance coverage of resources like rehab and home
health care. Often health care systems offer these services within their system, but insurance is a
determinant on if the continuity of care can continue at that health care system. Lastly, a condition
specific consideration is the fatigue and weakness that come from having heart failure. It will take some
time for C.S. to adjust to her new level of activity and will likely overexert herself frequently in the
beginning.
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References:
Centers for Medicare & Medicaid Services. (2023).
Hospital readmissions reduction program (HRRP)
.
CMS.gov.
https://www.cms.gov/medicare/medicare-fee-for-service-
payment/acuteinpatientpps/readmissions-reduction-program
Lehman, B. J., David, D. M., & Gruber, J. A. (2017). Rethinking the biopsychosocial model of health:
Understanding health as a dynamic system.
Social & Personality Psychology Compass
,
11
(8), n/a-
N.PAG.
https://doi-org.wgu.idm.oclc.org/10.1111/spc3.12328