Critically analyze a health policy at the local, state, or federal level and provide recommendations based on your evaluation. You will explore how this policy impacts clinical practice and make connections between policy and practice in nursing.
1. Prepare a Policy Analysis Paper (see following sections containing Rubric and Assignment details).
Goal: To incentivize hospitals to improve quality of care and care coordination, particularly during the transition from inpatient to outpatient settings, thus reducing unnecessary and costly readmissions.
The HRRP is a high-stakes policy that has successfully reduced national readmission rates but faces significant criticism regarding its equity and impact on vulnerable populations.
A. Effectiveness and Efficiency
Export to SheetsCriterion Analysis Effectiveness Positive: National readmission rates have declined since the program's inception, suggesting it has successfully driven hospital attention and investment toward care coordination (Joynt et al., 2020). Negative: Studies show that while readmissions fell, the use of observation stays (which are not counted as readmissions) increased, potentially masking the true impact or simply shifting costs (Jencks et al., 2018). Efficiency The policy is financially efficient from Medicare's perspective, as it saves money by reducing payments for poor performance. However, hospitals, particularly smaller or those with high patient volume, must invest heavily in new staffing (e.g., transitional care nurses) and technology (e.g., electronic health record integration) to avoid penalties, which may strain their operating margins.
B. Equity and Unintended Consequences
Criterion Analysis Equity (Social Determinants of Health - SDoH) Major Flaw: The HRRP disproportionately penalizes hospitals that serve a higher percentage of patients with complex SDoH (e.g., homelessness, poverty, lack of access to follow-up care or healthy food) (Wadhera et al., 2018). These factors are largely outside the hospital's direct control but significantly influence a patient's likelihood of readmission. The current risk-adjustment models do not adequately account for the socioeconomic challenges faced by patients. Unintended Consequences "Sicker Patients": Some research suggests that penalized hospitals may become reluctant to admit sicker patients or patients with complex SDoH out of fear of readmission penalties, potentially leading to increased mortality or care delays in the community (O’Connell et al., 2016).
A comprehensive policy analysis requires selecting a specific health policy and evaluating it against criteria such as effectiveness, efficiency, equity, and political feasibility. Since a specific policy has not been provided, I will select a widely relevant federal policy—the Hospital Readmissions Reduction Program (HRRP)—to conduct a critical analysis and provide recommendations as requested.
Policy: The Hospital Readmissions Reduction Program (HRRP) Level: Federal (Medicare/Centers for Medicare & Medicaid Services - CMS) Enactment: Part of the Affordable Care Act (ACA) of 2010.
Core Mechanism: The HRRP mandates that CMS reduce Medicare payments to hospitals with higher-than-expected readmission rates for selected conditions within 30 days of discharge. Currently, the conditions include acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), elective total hip and total knee arthroplasty (THA/TKA), and coronary artery bypass graft (CABG) surgery.
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