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Peer Review Measure Funding Paper

954 words - 4 pages

The quality measure proposed by Ms. Sheila Johnson for funding addresses the post-diagnosis care of pneumonia patients. More specifically, the measure addresses Medicare patients and the need for the appropriate transfer of care to prevent hospital readmissions. After evaluating the proposal and reviewing additional research, I believe in moving forward with the measure and providing the supporting funds.

Several criteria were used to evaluate the fundability of this project. These criteria include:
1) Does the project target a federally recognized problem?
2) Is there substantial evidence to support the project’s measure?
3) Will this project help hospitals save money and improve care?
The project strongly fulfills these criteria, thereby proving its rationale and fundability. The following is an analysis of each criterion used to assess the fundability of the project.
1) Does the project target a federally recognized problem?
Yes. The U.S. federal government has targeted pneumonia patient care as a major area in need of quality improvements. The project proposal explains:
The Patient Protection Affordable and Accountable Care Act introduced the Hospital Readmissions Reduction program in October 2012, which limited the reimbursement for additional readmissions for Medicare patients (Centers for Medicare and Medicaid Services, 2013). The program was introduced to eliminate preventable hospital readmissions for Acute Myocardial Infarction, Heart Failure and Pneumonia and to financially incent hospitals to improve the quality of care (Centers for Medicare and Medicaid Services, 2013).
Additionally, the Centers for Medicare & Medicaid Services (CMS) reported that avoidable readmissions are one of the biggest problems confronting U.S. hospitals.
2) Is there substantial evidence to support the project’s measure?
Yes, there is evidence to support the project’s measure. The evidence in support of the measure ranges from federal programs like the Readmissions Reduction Program that was enacted with the Affordable Care Act (2013) to news stories discussing the fines some hospitals have already received due a to high readmission rate (Wolfson & Campbell, 2014). There is also a wealth of academic research as well as national reports to support the need to measure the pneumonia post-discharge care.
3) Will this project help hospitals save money and improve care?
Yes. Evidence shows that reducing hospital readmissions will significantly impact hospitals resources. Medicare announced in 2013 that it would fine 2,225 hospitals within 49 out of 50 U.S. States for excess readmissions. The amount of the fine all together will total of $227 million (Kaiser Health News, 2013). Furthermore, the project proposal successfully highlights the financial implications of reducing pneumonia patient readmission. The proposal states:
The financial impact of Medicare readmissions for pneumonia could be significant. According to the 3M analysis of 2005...

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