Hospital Readmission Reduction Programs in Upstate New York: Correlates, Best Practices and Nursing Contribution

Background: Patients with heart failure and pneumonia continue to have poor health as evidenced by high admission rates. While New York State exceeds one billion dollars for heart failure and pneumonia, it also ranks 50th, the worst in the nation, for poor readmission rates. Additionally, quality of care is under more scrutiny because the Affordable Care Act penalizes hospitals with excessive readmission rates by lowering reimbursement to hospitals treating Medicare recipients. Reduced hospital reimbursements threaten the financial stability of hospitals and would impact proper nurse staffing a major factor in patient health and safety outcomes. Many hospitals have initiated programs but no studies have compared these various programs in order to determine which are more effective at lowering readmissions and reimbursement penalties.;Objectives: The study's purpose was to identify hospital programs and related factors that contributed significantly to reductions in hospital readmission rates and payment penalties for hospitals in upstate New York.;Methods: Using an ex post facto design within the framework of the ecological and synergy models, community and organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent t-tests, ANOVA, and Pearson's Correlation tests were conducted.;Results: Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (a) certified home health agencies; (b) telehealth; (c) house calls; (d) APNs on interdisciplinary discharge teams; and (e) increasing the number of hospital readmission reduction programs utilized. Community characteristics that improve outcomes include (a) hospitals located in counties with a lower health ranking score; (b) house calls in primary care shortage areas; (c) utilizing a greater number of hospital readmission reduction programs in primary care shortage areas; and (d) critical access hospitals.;Conclusions: Regulatory and financial support should be provided for the following organizational programs: certified home health agencies, telehealth, house calls, and APNs. On a community level, the allocation of resources for improving county health ranking needs to be a priority.