User:MeredithMimoso/sandbox

For my WP article, I am choosing to edit the existing page "Hospital readmission". The first edit I want to make is adding more to the Hospital Readmission Reduction Program section. I believe that the existing information gives a lot of good information on the history and how the rates are calculated, but I think more could be added about the studies that have already been done and also potential future studies. I have a few sources of studies that have been done, but I need to be careful in terms of adding information that I am following the Guidelines for Medical Content.

The next edit I want to make introduces more to Readmission Rates than just the HRRP. There are many other programs that are in place to help hospitals reduce their rates, or at least give them ideas in order to reduce the rates. While the HRRP is very structured and regulated, these are a little more laid back and less punitive. I want to add sections on the Community-Based Care Transitions Program (CCTP), Independence At Home Demonstration Program (IAHP), and National Pilot Program on Payment Bundling (NPPPB). To my understanding, the content on this article needs to have a relatively similar amount of information for each section, so I will develop a lot of information on the background of these programs and potentially a few studies to show how they have worked in the past. I will need to find all new sources for these 3 programs because my Literature Review was done only on the HRRP. I would ideally like to find 3 sources for each just on background, and then maybe 2 or 3 studies for each as well.

I think another type of explanation in this article could be the controversy around readmission rates in general. A readmission is when an inpatient is admitted (usually) less than 30 days after their initial admittance. However, if a patient comes in for the flu and is discharged a couple of days later, but then comes in after two weeks with a broken ankle, that is considered an admittance. So while the hospital may have done a great job in treating the flu, they are still penalized with the readmission. I would like to find a few sources highlighting this controversy and put this in, potentially after all of the different types of programs available. This will most likely be the most difficult part of the edits, as it is high controversial and most sources may have bias.

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Community Based Care Transitions Program

Section 3026 of the Affordable Care Act (7) created The Community Based Care Transitions Program (CCTP) was created January 1, 2011 (1) in an effort to reduce readmission rates. Congress agreed to fund $500 million to this 5-year pilot program, in hopes to aid the Community Based Organizations (CBO) in better quality care (2). A CBO is a “public or private non-profit (including a church or religious entity) that is representative of a community or a significant segment of a community, and is engaged in meeting human, educational, environmental, or public safety community needs”(1). CBO's are required to provide continuing care after the patients are discharged in one of five different ways. They must start the transition no later than 24 hours after the patient is discharged, provide timely, culturally, and linguistically accurate education to the patient, provide support specific to the patient's condition, review and manage the medication for the patient, or provide a timely interaction between post-care providers and outpatient services (10). The CBO’s provide education and medication administration to discharged patients in a way that fits their cultural and linguistic needs(2). They will review medications with the patients and provide oversight in medication administration (2). Most importantly, they help to create care plans that are shared between all aspects of the patients healthcare(1). These care plans are customized for each individual and are communicated in a collaborated information exchange (1). By having key communication between both the sending and receiving healthcare teams, CBO’s aid in reduced readmissions (1).

Independence at Home Demonstration Program

Section 3024 of the Affordable Care Act (8) created The Independence at Home Demonstration Program (IAH) that was announced in 2010 and later started in 2012 (3,4). It was originally intended to be a 3 year program, but was extended for 2 more years on June 2015(4). The intentions of the IAH are to use mobile teams of physicians, nurse practitioners, physician assistants, pharmacists, social workers, and others to aid in the treatment of chronically ill Medicare patients at their homes (3,4). By using mobile teams with electronic information technology, the IAH can improve coordinated healthcare and allow for chronically ill patients to be seen as often as needed (3,4). In order to qualify, patients must have at least 2 chronic illnesses, have been to a healthcare facility within the last 12 months, and have received rehabilitation within the last 12 months (3). The teams of physicians and nurse practitioners must serve 200 or more of these types of patients each year (3). By focusing on high cost and immobile patients, these teams can use mobile technology to align incentives and come up with the best possible plan for the patients (4). In doing this, the IAH has saved more than $25 million in costs since its inception (4). The top-performing team has even reduced costs as a whole by 32% (4).

Beneficiaries have benefitted from the IAH in multiple ways. On average, they have fewer hospital admissions within 30 days, have been contacted with a follow-up within 48 hours, and their medication is identifed by their provider within 48 hours (8). On average, they saved $3,070 in the first performance year and $1,010 per year during the second performance year, and still had the benefits of quality care (2 press releases).

Bundled Payments for Care Improvement (BPCI) Initiative

The Bundled Payment for Care Improvement (BPCI) Initiative Pilot Program was started in 1990 and intended to be a 5-year pilot program (6). It ultimately gives healthcare providers a bundled payment for all of the care done at the inpatient facility, post-acute care facility, and other outpatient services (5). The range of time for this care varies but the bundling time can start 3 days prior to the acute care (5). One of the advantages of the bundled payment program is that it incentivizes hospitals not to discharge patients too early, as the post-acute care facility will just have to deal with the implications that come with that (5). Over a 5 year period, the bundled payment program had saved $35 million for the government (6).

There are 4 different models that are incorporated in the BPCI Initiative. The first model is when the reimbursement is exclusively pay-for-service and paid based on the DRG. The second and third models are a mix of both pay-for-service and bundled payments. Lastly, the fourth model is stricly reimbursed in a bundled payment. As of April 1, 2016 the participants by models were 1 member, 649 members, 862 members, and 10 members, respectively. As is evident, there is a larger transition to bundled payments, as they allow for all of the healthcare providers to work more closely together.