In my last post I identified the CMS mandate to reduce readmission rates as a game changer. I see it as a major step in the direction of healthcare in the U.S. Under the new rules it is not sufficient to decrease length of stay. If the patient returns to the hospital within 30 days with the same diagnosis they jeopardize the overall CMS reimbursement if admitted. The initial change in the game will occur in the emergency department. Each patient will be scrutinized as a potential readmit and a process will be put in place to treat them aggressively to avoid admission if at all possible. I foresee increased use of 23 hour observation, non-invasive therapies, protocols, etc. There will likely be longer lines and longer waiting times, increased transports and transfers, at least initially, as patients are held longer and throughput is decreased. Hospitals will not only put the clamps on patients coming through its doors, they will begin rousing campaigns to follow up on all patients discharged from their services, especially those belonging to one of the identified DRG’s (AMI, CHF, PNA, COPD and certain post surgical patients). Programs will be established and funded to assess the patient’s status at home. Care will be taken (even at no cost!) to see that the patient is compliant with discharge orders, has access to medications, follows up with their primary care provider and essentially stays well! The endgame in all of this is an essential shift in focus from one of illness to one of wellness. It also moves the game out of the short term acute care arena! How do we as a Respiratory Therapist position ourselves to play effectively in the new game? I’ll go more into detail in my next post.