NHS FPX 6008 Assessment 3 Business Case for Change

Name

Capella university

NHS-FPX 6008 Economics and Decision Making in Health Care

Prof. Name

Date

Business Case for Change

Welcome to our honorable stakeholders. The current presentation is devoted to the problem of hospital readmissions in Detroit, Michigan, emphasizing the financial costs associated with readmissions for patients, healthcare organizations, and society. It presents the idea of solving the problem, explains how it can be done, and discusses the costs and benefits. It also focuses on equal, moral, and culturally competent ways to improve health outcomes for community members. 

Healthcare Economic Issue and Its Influence 

Hospital readmission rates, especially in Detroit, Michigan, remain a substantial issue in the healthcare sector. This issue is more so evident in Detroit because of the high poverty level (33.8%) and limited access to healthcare facilities (Barker et al., 2023). The implications of this specific issue are vast for all patients individually and have massive impacts on all providers and communities.

I know trenchantly that readmissions are costly and can exert pressure on the system, the overall quality of services, and the patient’s health. To my colleagues, readmitted patients overwhelm the health care systems since they keep returning, increasing workload and job dissatisfaction. It also complicates continuity in patient care and coordination between departments and makes staffing have to continuously deal with a lack of discharge planning and discharge follow-up processes. These disruptions tend to occur at the expense of preventive care and patient education, which are important for chronic disease management. 

Hospital readmission is costly to our organization, especially now that Medicare has started reducing payments by up to 3% for fee-for-service organizations with high readmission rates beyond the expected ones (Yang et al., 2022). Such penalties lower funding for staff training, hiring, and implementing care models that add value. In addition, they impact our corporate image as a healthcare organization that delivers quality services. At a community level, hospital readmissions affect low-income and minorities because it worsens the accessibility problem and the overall health status of patients. Consequently, the change implementation plan advances the principles of equal, patient-centered care and enhances the system deficiencies to eliminate readmissions. It is a chance to improve the results, assist peers, and build an effective healthcare future for the population.

Feasibility and Cost-Benefit Considerations

Feasibility Considerations 

Given the availability of evidence-based interventions and community resources, addressing hospital readmissions in Detroit is feasible. Transitional care programs (TCPs), including discharge planning, follow-up services, and patient education, have assisted in achieving change in readmission rates. Discharge planning is very feasible because it builds upon existing practices within the hospital to achieve continuity of care. In their study, Pugh et al. (2021) identified that better discharge planning leads to better patient outcomes, better care coordination, and reduced avoidable readmission costs. 

Furthermore, adequate follow-up care significantly reduces readmission rates by addressing gaps in post-discharge support. A study says that 50% of the Medicare beneficiaries who are re-admitted within 30 days of discharge had a follow-up visit with a healthcare provider (Dhaliwal & Dang, 2024), which means that half of the patients are not getting adequate follow-up care. Progress in care coordination and patient education also supports feasibility through the use of medical structures. These strategies assist patients with managing their care needs and guarantee the continuity of the provider. Studies prove that when care coordination and patient education are enhanced, patient health status improves, and hospitalization decreases (Dhaliwal & Dang, 2024).

Cost-Benefit Considerations 

The effectiveness of these measures in terms of costs can be explained by the findings of scientific works demonstrating reduced healthcare costs and improved treatment results. The literature indicates that implementing the transitional care program reduced 30- and 90-day readmissions and cost savings of about $500 per patient (Dhaliwal & Dang, 2024). A similar study provides evidence of the ability of the TCP program to decrease cases of early hospitalization and total health expenditure. The program also reduced 30-day and 90-day readmissions, as well as lowered total costs per admission (USD 22,439) as compared to the control group (USD 28,633), highlighting the program’s cost-effectiveness (Heo et al., 2023). Finally, such efforts save money under Medicare’s HRRP program, which costs billions of dollars for healthcare entities.

Mitigation of Financial Risks

Some of the financial risks associated with hospital readmissions are Medicare penalties, revenue loss due to long patient stays, and increased operating costs. These risks can overwhelm the healthcare setting’s resources and limit its ability to grow and be financially sustainable.

1. Enhanced Follow-up Care Programs: Post-discharge care coordination is an investment that can greatly help prevent readmissions. Organizations can conduct telehealth follow-ups and home care services, such as transition health coaches, to confirm further appointments and support the patients (Dhaliwal & Dang, 2024). This approach of not waiting for patients to be readmitted reduces penalties and operating costs that Medicare imposes, making a facility financially healthy.
2. Community Partnerships: Partnering with local community-based organizations can increase the availability of transportation, health information, and other related services (Obi et al., 2024). Such collaborations ensure patients, especially those from vulnerable groups, receive proper follow-up care after hospitalization, preventing early readmissions. Patients with strong community ties also have better outcomes and care costs are lower.
3. Data-Driven Risk Prediction Tools: Using big data to predict patient risk allows healthcare providers to intervene, provide individualized treatment, and track particular patients (Golas et al., 2021). By investing in the right patients and improving the quality of care and patient health, organizations can prevent readmissions and reduce the associated costs. This strategy helps avoid the waste of healthcare resources.

Proposed Changes to Address Hospital Readmissions

The proposed solution to address hospital readmissions in Detroit includes implementing a comprehensive Transitional Care Program (TCP). This program incorporates effective discharge planning, adequate follow-up care, and patient counseling to fill gaps in care transition (Heo et al., 2023). The TCP will require specialized staff, including care coordinators, nurses, and social workers, to follow up on high-risk patients after discharge. Key components of the program include:  

1. Enhanced Discharge Planning: Patients will receive individualized discharge plans based on the medical and social assessment. The plan will contain instructions regarding medications and appointments for the next visit and the list of community services. 
2. Follow-Up Services: Follow-up will be structured, and patients will be contacted within 48 hours of discharge and then weekly for the first month.
3. Patient Education and Support: Lectures on disease management, medication compliance, and early signs of deterioration will enable patients to be their managers.  

Potential Benefits of the Program 

 

• For the Organization: When implemented, the TCP can help decrease Medicare penalties by reducing readmission rates. For example, Yang et al. (2022) note that removing monetary sanctions under the HRRP program preserves organizational sustainability, shielding resources from progressive causes. Patient health will also improve, increasing hospitals’ performance and obtaining funding from increased patient flow and value-based care.

• For Colleagues: Care teams will profit from more efficient work processes, less workload due to frequent readmissions, and the intrinsic motivation resulting from a comprehensive care approach. Interdepartmental cooperation will also promote professional development and collaboration.

• For the Community: The program improves health access by eliminating barriers related to socio-economic status, including transport and understanding of health information. Vulnerable populations will have more access to the resources, enhancing their overall health. It is evident that transitional care models can help reduce readmissions by half (7.1% intervention group and 14.9% control group) (Heo et al., 2023). 

 

Through the TCP, hospitals will benefit from better financial situations, motivate healthcare employees, and contribute to healthier people in Detroit.

Solutions Addressing Cultural and Ethical Considerations

The proposed Transitional Care Program (TCP) aims to prevent Hospital readmissions in Detroit. It places a very high premium on culture, ethics, and fairness in health care delivery. It is designed to address Detroit’s multicultural population and numerous socioeconomic issues, which are acknowledged, such as cultural differences, disparities in health care, and equity. The TCP has considered the need to be culturally sensitive by involving the community and translating its resources. The teaching tools and discharge instructions will be provided in the main languages used in the community.

Ethnicity education for healthcare workers will improve their capacity to care for patients who follow their cultural and religious practices (Červený et al., 2022). Moreover, the program will include community and faith-based organizations because they influence the Detroit neighborhoods. The program will be more acceptable and effective if it is designed to fit into the cultural practices of the communities to be targeted. 

The TCP complies with beneficence, nonmaleficence, autonomy, and justice. It focuses on enhancing patients’ health, reducing adverse effects through early actions, and patient-focused information sharing (Heo et al., 2023). Patient centrism entails people setting their discharge plans and allowing them to choose how they want to be cared for. To eliminate the issue of financial barriers, the TCP builds on existing programs such as Medicaid to provide for the economic needs of the patients. Transportation to follow-up appointments will be offered, especially for those patients in rural areas. The TCP guarantees that, through critically incorporating equity into each implementation phase, all Detroit dwellers, including ethnically and economically diverse populations, can avail of quality transitional care support without incurring substantial costs.  

Conclusion

In conclusion, addressing hospital readmissions through an effective TCP program, including discharge planning, follow-up care, and patient education, presents a significant opportunity to enhance patient outcomes and financial sustainability. Healthcare organizations can reduce readmissions by mitigating Medicare penalties, reducing operational costs, and improving resource utilization. The proposed solutions, including follow-up care programs, community partnerships, and predictive analytics, offer feasible, evidence-based approaches to reducing financial risks while enhancing patient care. Ensuring culturally sensitive, ethical, and equitable solutions will further strengthen the impact of these initiatives, fostering a healthcare environment that prioritizes both quality care and financial security.

References

Barker, E., Hu, Dr. L., Alaswad , H., Fleming, O., & Klammer, S. (2023). Detroit economic indicators report. Detroitmi.gov.https://detroitmi.gov/sites/detroitmi.localhost/files/2024-04/Q2%202023%20Economic%20Indicators%20Report.pdf

Červený, M., Kratochvílová, I., Hellerová, V., & Tóthová, V. (2022). Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011–2021. Frontiers in Psychology, 13(1). https://doi.org/10.3389/fpsyg.2022.936181 

Dhaliwal, J. S., & Dang, A. K. (2024). Reducing hospital readmissions. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK606114/

Golas, S. B., Nikolova-Simons, M., Palacholla, R., op den Buijs, J., Garberg, G., Orenstein, A., & Kvedar, J. (2021). Predictive analytics and tailored interventions improve clinical outcomes in older adults: A randomized controlled trial. Npj Digital Medicine, 4(1). https://doi.org/10.1038/s41746-021-00463-y 

Heo, M., Taaffe, K., Ghadshi, A., Teague, L. D., Watts, J. C., Lopes, S., Tilkemeier, P. L., & Litwin, A. H. (2023). Effectiveness of transitional care program among high-risk discharged patients: A quasi-experimental study on saving costs, post-discharge readmissions and emergency department visits. International Journal of Environmental Research and Public Health, 20(23), 7136–7136. https://doi.org/10.3390/ijerph20237136

NHS FPX 6008 Assessment 3 Business Case for Change

Obi, C., Ojiakor, I., Etiaba, E., & Onwujekwe, O. (2024). Collaborations and networks within communities for improved utilization of primary healthcare centers: On the road to Universal Health Coverage. International Journal of Public Health, 69. https://doi.org/10.3389/ijph.2024.1606810 

Pugh, J., Penney, L. S., Noël, P. H., Neller, S., Mader, M., Finley, E. P., Lanham, H. J., & Leykum, L. (2021). Evidence-based processes to prevent readmissions: More is better, a ten-site observational study. BioMed Central Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06193-x

Yang, Z., Huckfeldt, P., Escarce, J. J., Sood, N., Nuckols, T., & Popescu, I. (2022). Did the Hospital Readmissions Reduction Program reduce readmissions without hurting patient outcomes at high dual-proportion hospitals prior to stratification? INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 004695802110648. https://doi.org/10.1177/00469580211064836 

NHS FPX 6008 Assessment 3 Business Case for Change