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Today, the healthcare system continues to function in a highly complicated environment. As suggested by the current policies, an additional emphasis on the quality of services is expected in order to meet the growing needs of the population. Nevertheless, healthcare faces systemic impediments, which prevent it from working at full capacity and fulfilling its potential. The issue of underinvestment has become especially acute in the United States, as this trend poses serious concerns within the medical community. Maani and Galea (2020) state that the brief surge in public health funding in the fallout of the 2001 terrorist attacks on the U.S. has been followed by a steady financial decline. As a result, the trend became reflected in the level of income received by the medical staff. The general job dissatisfaction has had a negative impact on the personnel’s ability to deliver high-quality services, which, in turn, caused a wave of public disapproval. Overall, the situation remains in a circle of underfunding, in which the increasing workload requirement is not met due to medical teams’ unwillingness to work under current circumstances.
As such, the healthcare system has recently seen the emergence of competing needs, which contradict one another. As mentioned earlier, the population’s demand for high-quality care remains on the increase. Patients address medical facilities for expert assistance, but the lack of motivation prevents workers from attaining the desired level of quality. In addition, the number of patients has also been growing steadily, and the situation took a particularly negative turn amid the Covid-19 pandemic in 2020-2021. According to Maani and Galea (2020), the healthcare system of the United States has been faced with challenges of an unprecedented magnitude. Thousand of new patients have been admitted daily, which raised the pressure on medical workers to critical levels. As a result, the need for higher capacity and better performance of the healthcare system was further highlighted by the pandemic. In other words, medical facilities are required to deliver their services better and more efficiently.
On the other hand, the aforementioned need enters a conflict with another tendency, which consists of optimizing the system’s expenses. As described in the previous sections, the lack of satisfaction and motivation is conditioned by the inadequate level of pay nurses and other workers receive for their stressful jobs. It is natural for any organization or system, in general, to aim at reducing expenses and optimizing profits. The circle of underinvestment entails the poorer quality of services, leading to higher readmission rates, thus impacting the system’s financial performance. The analysis by Poojary et al. (2017) returned an early readmission rate of over 10%, which signifies flaws in the primary care procedures. In order to address this issue, the healthcare system faces the need for higher wages, which would motivate the personnel to work more efficiently. Evidently, the inadequate level of reward for services demotivates a sufficient number of practitioners, resulting in poorer services and worse financial performance of facilities.
Effective state and nationwide policies may hold the key to resolving the healthcare stressor described above. The Hospital Readmissions Reduction Program (HRRP) is effectively implemented across various settings within the system. Its purpose is to promote better communication between medical teams and their patients during discharge planning, which, in turn, is expected to lower readmission rates in the United States (CMS, n.d.). A higher level of patient and family engagement has the potential to educate them on the particularities of recommended post-treatment procedures, thus contributing to two aspects of the issue at hand. From one perspective, if the policy is utilized correctly, it may significantly reduce the number of readmissions across medical facilities, thus improving their budgetary results. On the other hand, lower readmission rates alleviate the workload on the healthcare system, allowing facilities to function efficiently.
The HRRP is a relatively recent phenomenon within the scope of the country. It was established in 2012 by Section 3025 of the Patient Protection and Affordable Care Act (CMS, n.d.). Within the framework of the policy, unplanned readmissions within 30 days post-discharge are measured for the cases of pneumonia, heart failure, acute myocardial infarction, COPD, CABG, and THA/TKA (CMS, n.d.). The data is collected throughout the year and distributed among hospitals on an annual basis by the Centers for Medicare and Medicaid Services. Once the results are received, reviewed, and approved, the information is then considered when the budget for the following fiscal year is drafted. Overall, the HRRP is a comprehensive policy, which encompasses various facets of the relationship between facilities’ underfunding, readmission rate, and general performance.
At the same time, despite the topical status of the HRRP and the problem it addresses, the policy does not remain inherently positive. Evidently, the implementation of the initiative pursues a noble goal among others. Apart from the financial repercussions, readmissions have a purely ethical side, as well. If a patient is forced to return to the hospital and seek additional treatment, it means that the quality of initially received services was not on par. The HRRP focuses on acute conditions, which threaten an individual’s health and life to a considerable degree. Heart failures and pneumonia complications have the potential to incapacitate the patient or even be the cause of their death. Accordingly, the policy prompts medical teams to provide better treatment, as the lack of readmissions would mean the individual’s successful recovery.
Nevertheless, the primary ethical challenge of the HRRP lies in the instruments it uses to promote its purpose. One of the policy’s main principles implies that medical organizations with subpar readmission rates are penalized with further budget cuts. It is presumed that, in such cases, a hospital does not perform well enough and deserves to have its financing decreased. As a result, the level of medical professionals’ pay suffers, even more, contributing to further deterioration of the service quality. Consequently, such medical facilities remain stuck in a loop of budgetary reductions.
In these challenging times, the situation requires quality changes more than ever. As such, despite the perceived effectiveness and positive impact of the HRRP, the program’s details are to be addressed. The nature of the discussed healthcare stressor stems from the complex relation between underfunding and underperformance. As of now, the policy acknowledges it by devoting increased attention to readmission rates and considering them when making further decisions. However, the HRRP in its current state appears to focus on the surface without addressing more profound, underlying issues. The current distribution of funding aggravates the situation, as underperforming hospitals see the cause of their problem fueled even further. It is proposed that a different approach be utilized in this regard. If a facility’s readmission rate is below par, it can be offered a one-year, experimental budget increase to evaluate whether it can affect the situation. If the increase does not improve the outcome within the following fiscal year, it is to be canceled and redistributed to other hospitals. This way, underperforming teams will see additional motivation fixed by a nationwide policy.
References
CMS. (n.d.). Hospital Readmissions Reduction Program (HRRP). Web.
Maani, N. & Galea, S. (2020). COVID-19 and underinvestment in the public health infrastructure of the United States. The Millbank Quarterly, 98. Web.
Poojary, P., Saha, A., Chauhan, K., Simoes, P., Sands, B. E., Cho, J., Ullman, T., Nadkarni, G. & Ungaro, R. (2017). Predictors of hospital readmissions for ulcerative colitis in the United States: A national database study. Inflammatory Bowel Diseases, 23(3), 347–356. Web.
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