Lessening Re Hospitalization of Medicare and Medicaid Patients Capstone Project

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Preventing 30 Day Readmission on Medicare and Medicaid Patients

One of the most costly and common phenomenon in the modern healthcare system is the increased rates of readmission to hospital of Medicare and Medicaid patients within a short period after discharge i.e. usually within the first 30 days. These readmissions are usually caused by progression of chronic diseases among these patients as well as insufficient post-discharge care. Actually, insufficient post-discharge care is the major factor contributing to these preventable re-hospitalizations. Therefore, reducing the rates of readmissions to hospital of Medicare and Medicaid patients requires developing and implementing a new or enhanced plan for patients' follow-up after discharge. According to the findings of a recent survey, 22% of patients admitted to hospitals are either re-hospitalized or visit an emergency department within the first month after discharge (Harrison et al., 2011, p.27). This plan focuses on preventing readmission of these patients through post-discharge care based on follow-up.

Current Problem Requiring Change

As previously mentioned, the healthcare environment is increasingly characterized by high rates of readmission of Medicare and Medicaid patients since they suffer from chronic diseases. These high rates have partly been attributed to progression of the chronic illnesses but largely influenced by inadequate post-discharge care. The post-discharge care is insufficient because of poor communication between the patient and the health care team during and after discharge (Harrison et al., 2011, p.27). Recent surveys have indicated that approximately 22% of admitted Medicare and Medicaid patients are either re-hospitalized or visit and emergency room within 30 days of discharge if they don't die. The increased readmission has considerable impact on the health and well-being of these patients in addition to increasing health care costs.

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Therefore, it is increasingly important to develop effective plans for post-discharge care in order to improve patient outcomes and lessen health care costs.

Obtaining Approval and Support from Leadership and Staff

The first step towards the implementation of this plan on preventing 30 day readmission on Medicare and Medicaid patients is obtaining required approval and securing support from the organization's leadership and fellow staff. This will involve conducting a meeting with the leadership team in which the rationale and positive effects of the proposed plan will be discussed. These discussions will be carried out in a board meeting, which will review the organization's current environment and practices as well as examine the needs for implementing an evidence-based project. Similarly, securing support from fellow staff will entail discussing the current best practices in lessening readmission rates and how these practices will be incorporated in the organization. During this process, the roles and responsibilities of the staff in the implementation of the proposed project will be discussed and clarified.

Explanation of Proposed Solution

The proposed solution for preventing 30 days readmission of Medicare and Medicaid patients is a process or procedure that focuses on post-discharge care through follow-up phone calls after discharge and follow-up appointments with primary care physicians. Generally, follow-up phone calls by nurses after patient discharge have widely been adopted as a means of enhancing patient satisfaction and outcome while ensuring continuity of care (D'Amore et al., 2011, p.249). In this case, the follow-up phone calls and follow-up appointments with primary care physicians will be implemented as part of the health plan for improved patient outcomes through reducing….....

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"Lessening Re Hospitalization Of Medicare And Medicaid Patients" (2015, November 26) Retrieved May 14, 2024, from
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"Lessening Re Hospitalization Of Medicare And Medicaid Patients", 26 November 2015, Accessed.14 May. 2024,
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