RESUMO
Safety net community hospitals face unique challenges when entering risk-based contracts. The financial viability of such programs in these settings has not been well studied. This study analyzed a bundled-payment program for congestive heart failure at one such facility. To assess financial performance, the authors calculated the net patient payment by quarter after bundle implementation, and also compared the leading cost drivers before and after bundle implementation, specifically the next site of care and readmission rate. After 21 months of participating in the bundle, the program has saved money, been financially feasible, and generated positive returns for the hospital. Admission to skilled nursing facilities decreased from 21.3% to 16.0% after bundle implementation. The readmission rate was not significantly different, but trended downward. This study shows that safety net community hospitals can successfully participate in a bundled-payment program. For heart failure patients, decreasing admission to skilled nursing facilities and lowering the readmission rate are essential for program success.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/economia , Hospitais Comunitários/economia , Provedores de Redes de Segurança/economia , Insuficiência Cardíaca/terapia , Humanos , Aquisição Baseada em Valor/economia , Aquisição Baseada em Valor/estatística & dados numéricosRESUMO
The Patient Protection and Affordable Care Act of 2010 (ACA) significantly impacts bedside nurses who must participate in organizational change and provide resources to patients. A health reform educational needs assessment was distributed to nurses from a midsized community hospital located in an elevated-need and medically underserved area in New England. Many nurses indicated that more knowledge was needed and they lacked information about the educational incentives. Health policy professional development opportunities are required to inform bedside nursing practice.