Managed Care: Readmission Reduction in Mental Healthcare Essay Example
Managed Care: Readmission Reduction in Mental Healthcare Essay Example

Managed Care: Readmission Reduction in Mental Healthcare Essay Example

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  • Published: December 23, 2021
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The importance of readmission reduction in healthcare is something that is well documented across the entire healthcare. This is likely due to the current penalties through the Centers for Medicare and Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). According to the National Committee for Quality Assurance, “preventing avoidable hospital readmissions is considered by many to be one of the most important opportunity for reducing waste in health care” (National Committee for Quality Assurance, 2012). In the field of nursing care management, it is recognized that readmission reduction is a primary focus within the scope of care and especially within vulnerable population management. In mental healthcare, “repeated hospitalizations on a psychiatric unit, affecting primarily the seriously mentally ill, are a substantial problem.

Between forty percent and fifty percent of patients with a history of repeated Psychiatric hospitalizations are readmitted with

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in 12 months. (Gaynes, Brown, Lux, Ashok, Coker-Schwimmer, Hoffman, Sheitman, & Viswanathan, 2015).” The associated costs related to readmission are astounding. Data on readmission highlights the scale of these problems within Medicare and Medicaid programs. “In 2010, the readmission rate for Medicare beneficiaries was 19.2% which cost the Medicare & Medicaid programs $17.5 billion annually” (Centers for Medicare & Medicaid Services, 2012). When patients return to the hospital for readmission, it is primarily due to issues with medication compliance, resource utilization, and follows through with the established plan of care.

A 2013 study from Mittler, O’Hora, Harvey, Press, Volpp, & Scanlon highlighted these problems and found 3 key factors which contribute to the prevention of progression in readmission reduction: “the dif?culty of developing a good collaborative relationship across care settings, gaps in evidence for effective interventions, and de?cit

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in quality improvement capabilities among some organizations.” Understanding the reasons for a particular readmission and finding appropriate and sometimes innovative ways to improve transitional care is an essential component in readmission reduction goals. This can be especially daunting within the mental healthcare setting due to compliance issues. The task for ensuring treatment compliance was noted by Ivn Montoya that “treatment compliance may be influenced by factors associated with the therapist's characteristics, the service, the nature of the treatment and the patient's idiosyncrasies. (Montoya, 2006)” He went on to say that “a treatment that may involve a complex procedure, is hard to follow, has unpleasant side effects, take a while to produce the desired effect, and is either unavailable or difficult to access and may increase the chances of poor compliance.

(Montoya, 2006)” It is imperative that care management models are applied in care transition which will allow for improved patient outcomes, the subsequent decrease in readmissions, and associated cost reductions within mental healthcare.

HRRP

Great efforts are underway to address the widespread issues related to hospital readmissions. Most of these endeavors are due to the implications of the HRRP, which was instituted in 2012 by CMS. Although the intentions of the HRRP were to incentivize hospitals to reduce readmissions, there have been mixed reviews of the program which are likely due to the financial penalties placed on hospitals. The readmissions of the mental patients are costly and also disruptive to the various individuals and their families too. This can lead to both the mental care providers and the patients having the feeling of being demoralized or experiencing a sense of failure.

Although this readmission may be due

to different causes such as increasing the severity of the patient’s psychiatric illness, lack of adequate community resources issues, improper and ineffective in patient care or sometimes lack proper adherence to the out-patient care. Usually, a decrease in the number of the psychiatric admission is measured over a span of thirty days (30 days), 90 days or sometimes annually (McIlvennan et al . 2015) This decrease is often used to measure the rate of success of discharges planning and the outpatient’s mental health treatment. To get accurate measures of the data, one can only confound by certain factors such as the readmission penalties, the psychiatric bed availability and lastly the use reviews of the admission related policies of the mental care hospitals. With the current increasing pressure by government agencies to reduce the cost of health care, reducing the psychiatrist hospital bed day has been made a priority for the providers and the insurers.

In a study that is documented in the American Journal of Medical Quality, by Albert, J.S and Harries the results showed several characteristics which may predict 30-day readmission in this population including male sex, increased age, length of stay, and a Charlson score of greater than 3.this is a clear indication that the psychiatrist readmission is a common scenario especially in the mental health hospitals. According to the study carried out by Berenson ET .al the Experts suggest an alternative "fee for service" or "single price" approach to solving the CMS readmission penalty dilemma. In essence, coverage would cover all procedural costs associated with treating a disease or condition and would include a "90-day warranty" type of model. Cost-effectiveness of readmissions would

be self-regulated from hospital to hospital as each organization would be compensated based on a pre-determined set rate.

There are key factors that help in decreasing the probability of subsequent patient’s readmissions that include the following:

  • Adequate discharge plan of the mental health patients

Putting into place an adequate discharge plan of the mental health patients and ensuring delivery of adequate support services especially in the transition of the psychiatrist-patient form inpatient one to an outpatient one. According to studies, the transitioning period following discharge carries a lot of risks especially for the patients with serious mental illness (SMI).The risk vary and mostly may be severe such as symptom relapse, an increased risk of homelessness, emergence of violent behaviors, some may result in killing themselves and in some instances the hospital readmissions. Although all these risks are properly documented, inadequacy in the proper planning among the patients and the care providers may lead to their re-occurrence upon discharge. Thus, a proper and adequate planning is necessary, and this will reduce the readmission rates (Cuffel BJ, Held M, Goldman,2002). According to Martin, M-L., Jensen, E., Coatsworth Puspoky et.al there are various models that been forwarded and tested especially in the general health area and they have shown that the elderly people are more vulnerable to hospital readmissions that the young people (general population).this is related to generally suboptimal health, disease-specific issues, family, and social factors.

Martin and the fellow researchers put a focus on several interventions that are aimed at reducing the rate of readmission in the hospitals rates. The care and intervention Model (CTI) are the most commonly used care post-hospitalization care for the mental

patients. The major goal of the CTI is to help the patients and support then to promote their knowledge in the self-management during the transition period from the hospital. The CTI model is based on four major pillars that are, uses of a changing patient-centered record (PHR) a patient skill of the red-flag, a care and specialist follow-up which is usually patient initiated and lastly a medication self-management.

This gives rise to the four components of care and intervention Model (CTI).The components include: a checklist which is structured to display the critical activities so as to empower the mental patients pre-discharge, a patient-centered record, an adequate transition and a frequent follow-up visit by the patients care taker and finally the patients self-activation and management session with the hospital specialist. This transitional discharge model provided mental health clients with peer and inpatient staff support in order to bridge the transition from hospital staff to a community provider. However, there were some challenges and opportunities identified across all clinical sites that are a district. Challenges The challenges to the implementation of this model include:

  • Training of the stuff
  • Acknowledgment of the transition gaps that is existing between the health care systems.
  • Understanding the different parameters of communication between patients and getting alternative ways of patient follow-up after discharge from the hospital.

Opportunities

  • Utilization of the model will reduce the hospital readmission rates

In addition rendering of the sufficient inpatient care so as to address the problems that may be acute to stabilize the patients mental status is a key instrument towards the e reduction of the hospital readmission rates. The Short-Term Alternatives to Psychiatric

Re-hospitalization Crisis residential care is a treatment methodology that is accessible outside a person's home on account of psychiatric destabilization not requiring involuntary responsibility. It exists in numerous structures but it is intended to be less prohibitive and less costly than regular inpatient psychiatric care, and in this manner considered an alternative.

It is additionally expected basically for people deliberately looking for treatment without a considerable comorbid psychiatric needs that would require an inpatient level of care. Scheduled irregular hospitalizations are arranged in short-term psychiatric inpatient admissions for individuals with genuine mental instability running from 3 to 11 days each three months. The long-term measures for curbing re-hospitalization According to research, there are various long term strategies that reduce psychiatrist-patient re-admission to hospitals. There are in fact four of the main categories.

  1. Collaborative care
  2. Involuntary outpatient commitment
  3. Intensive and non-intensive case management
  4. Assertive Community Treatment
  5. Support by peer
  6. Outpatient services and
  7. Psychoeducation.

Assertive community treatment

Assertive community treatment is usually an evidence-based practice for the treatment of people with serious and tenacious mental instability and late history of rehash psychiatric hospitalizations, involvement in criminal activities, vagrancy, and comorbid substance. This model depends on a multidisciplinary group made up of social specialists, a rehabilitator, medical attendants, and a specialist with a low client-to-staff proportion, successive visits in the group, every minute of every day accessibility, and the capacity to give complete services, besides a self-assertive community outreach for people requiring help with taking part in treatment.

This model of treatment is intended to give profoundly individualized wraparound benefits so that a patient does not need to work with numerous providers and can be helped through most

psychiatric emergencies without hospitalization, and hence, give care at all prohibitive environment. Originally spearheaded in the late 1970s in Madison, Wisconsin, ACT was produced as a component of a "quest for distinct options for mental clinic treatment for patients that experience the ill effects of chronically disabling psychiatric illness." (Walraven et. Al 2013) consequently, modified structures (with bigger caseloads and diminished visit frequencies) have been made to fit the local financing and work force limitations, especially in developing nations. Results highlight that relative reductions in the total number of readmissions are notably lower than that for potentially avoidable readmissions and the separation in relative reduction of all and potentially preventable readmissions increases as the proportion of readmissions considered potentially avoidable decreases (Walraven et. Al 2013).

The empirical evidence of ACT model

ACT depends on logical behavioral standards (e.g., Törneke And Romero, 2008) as expanded and extended out by a fundamental science record of dialect and cognition, Relational Frame Theory (RFT;) byHayes et al., 2001). RFT is a dynamic conduct explanatory examination program prompting major applied program that goes beyond ACT fundamentally, in such areas as improvement of the feeling of self furthermore, dialect preparing (Rehfeldt and Barnes-Holmes, 2009). RFT analysts have demonstrated that language mostly depends on the capacity of learning of differnt newborn children (Lipkens, Hayes, and Hayes, 1993; Luciano, Gómez, and Rodríguez, 2007) to determine self-assertive relations among occasions and to have the elements of occasions change subsequently (Hayes et al., 2001). Review of the evidence According to the research by Hayes, the experimental evidence is correlated with the psychological symptoms, and they negatively affect the quality of life and the general health measures.

ACT does not ordinarily try to prepare particular forms of thought. Or maybe, it endeavors to unwind verbal knots by extricating the ties of dialect itself.

For instance, rather than investigating one's victories as a method for making a thought of "I can do it!", in an unstable individual's mind, ACT endeavors to direct the individual to notice that thought is only an idea and to take required actions paying little attention to the many thoughts that may exist. ACT endeavors to undermine extreme combination by changing the way one connects with or identifies with thought, sentiments, and body sensations. In ACT, cognitive defusion and care methods are utilized to provide a more flexible and adaptable environment for difficult thoughts, partially by making the continuous process of thinking more clear. Defusion strategies often change the functional context of the cognitive events. Consider the thought, "I'm no great." Conventional psychological, behavioral treatment may attempt to lessen the frequency of the idea, challenge the legitimacy of the idea, or request that Thought to be tried in this present reality.

These methodologies treat the idea itself as though it is imperative. An ACT advisor may rather have that individual watch that idea float by like a cloud in the sky, and repeat the same thought many times so everyone can hear until only its sound remains; imagine it is a substance and give it a shape, size, shading, or speed; or any of scores of comparable procedures. Magritte's popular painting gives an exemplary defusion illustration: He portrayed a funnel and underneath it composed "Ceci nest pas pipe" ("This is not a pipe."). The desired aftereffect of such techniques and numerous

others like these is a decline in the authenticity of, connection to, or effect of private considerations and encounters as opposed to prompt change in their recurrence. A recent study found a large increment in pain resistance by having members first read aloud while strolling around the room as a defusion exercise some time recently going into the pain challenge. The announcement? "I can't stroll around this room." (McMullen et al., 2008).

Probably when later experiencing the pain, the contemplations, for example, "I can't stand this" had less effect on the patient The advantage of the ACT is that unlike the other methods, it does not view the mental patient as broken rather than as an equal to the psychologist. It emphasizes most on empowerment; that is a rich, meaningful value-based patient. Pain that is experienced is taken to be as life and not a burden to get rid of. Also ACT does not define the one's progress by the level of achievement rather but by the further increased choice of embracing the present and living a worthwhile life.

The Involuntary outpatient commitment (OPC)

The involuntary outpatient commitment is a type of mandatory outpatient psychiatric treatment that includes some level of legal implementation. The OPC requires expansive variations given the jurisdiction and particular State/Nation law. For instance, the commitment outpatients laws in the United States require a judge's request, which should be seconded by clinician information, and largely don't permit patients to be forcibly given drugs. Mandatory treatment orders, also referred to as community treatment orders, can frequently be actualized by a clinician, without the requirement for court inclusion, and in a few nations, for example, Australia

and Canada, the organization of intramuscular forced medication is permitted as a major aspect of the court order. These concept of mandatory outpatient treatment developed from various powers, including deinstitutionalization of those people with serious psychiatrist sickness starting in the 1950s, rising hospital center readmissions, public concern emerging from rare, but appallingly violent acts submitted by people with serious psychiatrist sickness living in the community, who were frequently observed to be non-adherent to treatment.

OPC/CTO obliges people to take part in psychiatric treatment in the community for a specific time frame or be confronted with readmission to the hospital for treatment and often involves information from clinicians and the legal framework (Jespersen, S., Chong, T et.al 2009). This means that a few People might require involuntary treatment to avoid readmission in light of the high predominance of anosognosia, with extreme and persistent mental illness. Specifics of the requests, for example, whether the drug can be forcibly administered by intramuscular injection and what conditions should be met to re-hospitalize a patient involuntary, vary from one particular State and nation. However, all the OPC is based on compelling outpatients services treatment will help avert re-hospitalization and overall reduce the high rate. Various factors were identified as contributing to successful discharge. The role of case management was found to be most successful when facilitated with the treating doctor, as well as early GP involvement.

With the judicial involvement, hospital re-admission can generally be reduced (Jespersen, S., Chong, T et.al 2009).

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