Purpose: Comment the Discussion / Class 1 Unit 9
THINGS TO REMEMBER:
• Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.
• 1 References, find resources that are 5 years or less
• No errors with APA format 6 Edition
Discussion :
In my current role, the team I work with is responsible for reporting various metrics required by (Hamric, Hanson, Tracy, & O'Grady, 2014) both The Center for Medicare and Medicaid Services (CMS) as well as the Ohio Department of Medicaid (ODM) (p.646). We are challenged to reduce 30 day hospital readmissions across the state of Ohio for all lines of business. Our internal goal is to have less than 11% of our adult and geriatric population readmit into the hospital in 30 days to help support this initiative (Centers for Medicare & Medicaid Services, 2017). When this massive goal was given to my team, our status was 23%. This meant we had to change the way we thought, worked and targeted our patients.
The first step was to identify were the highest utilization was occurring within the state. I suspected that we would see the highest utilization in our major market areas which included Columbus, Cincinnati and Dayton. I then met with our reporting and analytics (R&A) team to map out what fields I needed to appear in this report as well as what data logic I needed for them to include in order to receive the data I needed to strategize our plan. I was not surprised to see that my hunch was very close in that the three areas I suspected to have the highest utilization were in the top four as Cleveland tied with Dayton.
Once I had the volume of utilization, I then needed to determine the reason why these patients were readmitting. So, I went back to our R&A team and asked for them to pull in additional information to include the admitting reason based on submitted claims as this will provide the risk factors (McIlvennan, Eapen, & Allen, 2015) associated with hospital readmissions.
This is work that I do every day as I am charged with operating a transition of care team across the state of Ohio and helping our patients to receive the services they need to maintain their health in the least restrictive environment. I feel fortunate that my experience thus far has given me a lot of skill in data management at this point.
Reference
Centers for Medicare & Medicaid Services. (2017, July 11).
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2014). Advanced Practice Nursing. St. Louis, MO: Elsevier Saunders.
McIlvennan, C., Eapen, Z., & Allen, L. (2015). Hosital Readmissions Reduction Program. HHS Public Access, 131(20): 1796-1803.