Posted: March 12th, 2023

week 5 discussion

attached 

· Review the information on chronic conditions from the Center for Medicare and Medicaid Services (CMS)

Chronic ConditionsLinks to an external site.

 web page. Note that this web page outlines a series of chronic conditions for which extensive data is gathered and monitored as part of the CMS.

On the Chronic Conditions web page, download the zip file 
Utilization/Spending State Level: All Beneficiaries, 2007-2017, which contains data related to utilization and standing.

From the zip file, save the four most recent calendar year Excel worksheets.

For each calendar year, review the “ED Visits” and “Readmissions” data recorded by each state for the critical chronic conditions monitored by CMS.

For your home state, evaluate both the “ED Visits” and “Readmissions” data from each of these four years for diabetes, heart failure, and a mental health related chronic condition of your choice.

In your initial post, discuss the trends in the data from your evaluation. Additionally, research the financial impact of one of your evaluated conditions on the U.S. population, and recommend one type of performance improvement initiative in the delivery of hospital services that may affect the financial trends found in your data.

THINGS TO REPLY TOOO

Hello all,

For this week’s discussion, my home state of California’s ED visits and readmissions for depression, diabetes, and heart failure were evaluated. Staring with ED visits, the ED is one of the last places anyone would want to end up in. From the agony of what seems to be an eternal wait to see a doctor to the cost of being there, weigh heavily on the mind. According to Moore and Liang (2020), there were 144.8 million total emergency department visits in 2017 with aggregate ED costs totaling $76.3 billion is the United States. From 2017 to 2019, the average emergency department wait time for a discharged patient in California was 162 minutes in 2017, 156 in 2018, and 162 in 2019 (Hsia, 2021) . Depression ED visit figures for California from 2015-2018 trended up, but then took a downward dive from the highest in 2017 at 1473.8 to 1437 visits per 1000 beneficiaries in 2018 (CMS). While the ED visit number for depression went down, the overall spending per capita from 2015-2018 increased every year from $25,175.10 in 2015 to $27,074.60 in 2018 (CMS). Diabetes and heart failure shared a very similar trend to depression, with both trending upward from 2015, but then going down in 2018. One thing to keep in mind as well, readmission rates for all three conditions mentioned did not fluctuate much at all in the 2015-2018 time frame. 

When looking at the actual per capita cost for depression, hospitals can take action to help reduce those per capita costs. By investing in mental health community outreach programs, depression can be highlighted and that can lead to better individual education which in turn could lead to an earlier diagnosis from a medical provider and not an ED. By diagnosing early and preventing a possible ED visit, costs will be reduced and ED wait times can be impacted in a positive way as well. Education and early diagnosis are key. 

References

CMS. (n.d.). 
Chronic Conditions. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main

Hsia, R. (2021, December) California Emergency Departments: A Critical Source of Care. California Health Care Almanac, 2021.

Moore, B. J. , Liang, Y. (2020, December 8). 
Costs of Emergency Department Visits in the United States, 2017. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK566654/

NUMBER 2

Hello everyone,

My state in Maryland and the 4 years I found were 2015 – 2018.

For Diabetes (DM) in the ER for year 2015 visits were 1,014.5 and by year 2018 the trend was slightly down at 989.3.  Depression in the ER for year 2015 was at 1675.0 and by year 2018 it was fairly stable at 1522.9 which is just steady but slight decrease.  Heart Failure in 2015 at 1843.0 and had a dip in 2016 with 17.87.9 and back up in 2017 at 1824.0 and remained steady in 2018 at 1820.1.

The readmission rate for DM (Diabetes) in 2015 was at 24.1 and slightly decreased in 2016 at 23.4 and remained steady for the next 2 years. 2017 at 23.1 and 2018 at 23.5. While for Depression for year 2015 visits at 25.1 and remined fairly consistent to 2018 at 24.2 no noticeable increase.  And for Heart failure in 2015 the rate was at 27.3 with also very slight decrease by 2018 at 26.4.

The information that I found on the burden of diabetes in Maryland is from the American Diabetes Association. In it the discussion states about 10.8% of Maryland population have a diagnosis of diabetes.  And an additional 139, 000 people do not know that they have DM. Most people do not know how this condition can affect their life – it can impact kidney function, circulation, heart and eyesight to name a few.  Also, some people that know that they have it are in denial and do not take care of it and follow proper treatment. When these conditions flare up it and impact the Emergency Rooms and also impact readmissions. The state of Maryland has a current readmission reduction incentive program (RRIP) to help decrease readmissions to hospitals with 30 days of discharge. This incentive program will reward up to 0.5% of inpatient revenue to facilities when there is reduction due to socioeconomic disparities in readmissions. There are key measures that must be met to be eligible for this incentive. These can be found on the State Health Services website.

Main.diabetes.org/dorg/docs/state-fact-sheets/

ADV_2020_State_Fact_sheets_MD (diabetes.org)
Links to an external site.

https://hscrc.maryland.gov/Pages/init-readm-rip.aspx
Links to an external site.