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  1. Summers, Michele L. PhD, RN-BC, FNP-C
  2. Atav, Serdar PhD


Purpose of Study: The study's purpose was to identify hospital programs, organizational characteristics, and levels of nursing involvement in hospital programs that contribute significantly to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York.


Primary Practice Setting: Hospitals located in upstate New York.


Methodology and Sample: No sampling technique was employed because the cohort included hospitals located in upstate New York. Hospitals in upstate New York were selected (N = 94), representing 53 counties ranging between metropolitan and rural status. Using an ex post facto design within the framework of the ecological and synergy models, organizational characteristics of hospital systems and educational levels of nursing involvement in hospital programs were analyzed and coded. Independent-samples t tests, analysis of variance, and Pearson correlation tests were conducted.


Results: Organizational programs that reduce various hospital readmission rates and reimbursement penalties for hospitals in upstate New York are (1) certified home health agencies; (2) telehealth; (3) house calls; (4) advanced practice nurses on care management interdisciplinary discharge teams; and (4) increasing the number of hospital readmission reduction programs (HRRPs) utilized.


Implications for Case Management Practice: Hospitals should:


* Encourage and provide support for their case management departments to increase utilization of certified home health agencies, telehealth, and house calls, which contribute to reductions in readmission rates and decreased reimbursement penalties.


* Incorporate advanced practice nurses into case management teams for improvement in the excess readmission ratio for pneumonia.


* Continue to support government and hospital policies that increase resources for evidence-based HRRP initiatives and that improve Medicare reimbursement formulas.