KC
Student ID # XXXXXX
D520: Healthcare Leadership and
Administration Capstone Task 3:
Business Plan
Reducing Readmission Rates Due to
AMA Discharges
,Create a business plan (suggested length of no more than 25 pages) for your proposed solution
from Task 2: Prospectus by doing the following:
A. Summarize the following points:
• the healthcare challenge or need
• your proposed innovative solution
Over the past sixty years, the rates of patients who go against medical advice to discharge
themselves (DAMA) from an inpatient hospitalization have increased (Haines et al., 2020). A
recent study showed that DAMA discharges account for over 338,000 inpatient
hospitalizations, with an average annual increase of 1.9% (Haines et al., 2020). The
consequences for a DAMA patient, leaving before their physician has completed treatment of
their acute care needs, can be dire, including a higher risk of 30-day readmissions (for
treatment of the same issue), repeat DAMA events, and worsening of their clinical condition
with a higher risk of death (Southern et al., 2012). DAMA events can lead to readmissions that
cost up to 56% more to treat than would be expected had the patient remained for the initial
hospitalization through to a physician-ordered discharge (Alfandre, 2009). A 2020 study found
that readmissions for patients who leave against medical advice accounted for more than
400,000 inpatient days, with a cost burden for healthcare of more than $800 million annually
(Tan et al., 2020).
The most common reasons that patients decide to leave before their acute care treatment is
completed, are related to personal or financial obligations (Haines et al., 2020). In my own
experience as both a former bedside registered nurse and now as an inpatient medical coder, I
daily see patients who are willing to risk their health and their lives to get home as the sole
caregiver of a dependent spouse, parent, or child. Other reasons may include the need to return
to work, or for others, once they feel better after their immediate acute needs are met, they see
no point in continuing treatment (Haines et al., 2020), such as additional days to complete an
entire course of IV antibiotics or continued observation of a condition that the physician feels
remains clinically unstable. Still others may object to the non-smoking campus, or they have
other addictions that override their willingness to stay for a complete course of treatment
(Alfandre, 2009).
A solution for hospital organizations to mitigate DAMA events is to meet the patient where
they are and offer (for patients who qualify) a patient-centered model that fuses home health
care and hospital-quality acute care that is delivered in the patient’s home. Acute care at home
(ACH) is a program that bridges the gap in care by providing the same clinical care,
medications, supplies, equipment, and services that the patient would have received as an
inpatient in the hospital setting. By caring for the patient at home, the patient will receive their
full course of treatment to resolve the acute issues during an initial encounter, while allowing
the patient to attend to their personal needs or obligations as tolerated without further risking
their health and potentially their lives.
By removing the barriers to remaining inpatient for care, an organization can better meet the
patient’s needs by largely reducing—or eliminating—the risk of readmissions (thereby
reducing the cost of healthcare delivery), improving the patient’s healthcare experience and
1
,satisfaction, and improving population health (including reduced mortalities), all of which
support an organization in meeting the triple aim of healthcare (Berwick et al., 2008).
B. Discuss your value proposition by doing the following:
1. Predict the anticipated benefits of the proposed solution in terms of health outcomes
and population health.
Health outcomes: Patients who leave as a DAMA discharge are leaving before treatment is
completed to fully resolve their acute care issues; this inadequate treatment can leave the acute
condition to progress into something more difficult to treat, prompting a readmission
(Alfandre, 2009). For example, if a patient with cellulitis due to an infected leg wound is
admitted for IV antibiotics, but decides to leave later the same day, he is greatly increasing the
risk of the untreated infection worsening and spreading, perhaps into his bloodstream (sepsis)
(Healthdirect, n.d.). What had been a localized infection requiring several days of IV
antibiotics is now a systemic infection and a medical emergency that will require readmission
to the hospital and treatment that may keep him longer than if he had stayed with the initial
admission (GlobalData Healthcare, 2024). Sepsis is a life-threatening complication from an
infection, and depending upon the patient’s age and co-morbidities, the risk of mortality may
be extremely high (GlobalData Healthcare, 2024). In fact, even for patients who have
recovered from sepsis, there remains a high probability that they will die within a short period
of time afterward, for some within two years (GlobalData Healthcare, 2024).
Had this same patient agreed to complete the prescribed treatment for his cellulitis, whether
inpatient, or through an acute care at home program, clinicians would have been able to
closely monitor the localized infection to ensure that it was fully treated without further
risking complications that may include life-threatening sepsis (PSNet, 2021). He would have
experienced a positive health outcome with the initial encounter without the added health risk
and financial burden of a readmission, as home care programs can reduce readmission rates,
shorten the length of treatment and costs, with fewer complications than the patient would
experience without adequate treatment (PSNet, 2021).
Population health: Public health departments, as well as other agencies such as the U.S.
Centers for Disease Control and Prevention (CDC), utilize science-based, data-driven
monitoring and tracking of diseases to protect our nation’s public health (CDC, 2024). County
public health data is used to inform a local community and individuals regarding diseases,
threats, or other underlying conditions that may impact our health (Maricopa County, n.d.).
When patients leave the hospital prematurely, reportable diseases that qualify as contagious,
severe, or frequent cannot be fully tracked; information that is impactful on population health
from national, state, and city sources (CDC, 2024) is then compromised or lost altogether.
By ensuring that acute care patients remain admitted for treatment, either inpatient or through
an acute care at home program, data collection is complete, may be reported to appropriate
agencies, and is available for the organization to identify health trends and needs within the
community it serves and develop strategies to meet these needs and improve its population’s
2
, health.
2. Explain how the key stakeholders identified in the prospectus could be impacted by
the proposed solution.
Internal: For patients, they may be positively impacted by an acute care at home program that
provides adequate clinical treatment of their acute care condition to support resolution of the
issue during an initial encounter, while reducing costs and the risk of readmission for the same
issue (PSNet, 2021). Care outside of the clinical setting also helps to reduce the patient’s risk
of exposure to hospital-acquired conditions, infections, or injuries. Clinical providers will
benefit in knowing that there is an alternative available (for patients who qualify)
(Professional Solutions, 2022) to reduce the risk of a readmission due to a worsening
condition, and this is especially true for emergency physicians and nurses, for whom
preventable return visits will not overburden an already busy department (Sartini et al., 2022).
With reduced incidence of readmissions, hospital administrators will experience less challenge
in managing the additional resources that are needed for a readmission, including bed
utilization, more labor time for clinical staff to assess the patient’s complications, and wasted
resources for care (diagnostics, medications, supplies) that would not have been required had
the patient remained for full treatment during the initial encounter (Alfandre, 2009).
External: The patient’s family or primary caregivers will be positively impacted as the patient
may be needed at home to assist with family matters or the care of a spouse, parent, or child.
They can feel reassured with less anxiety that their family member is still receiving the care
they need, even if they refuse inpatient care (Bressman et al., 2021). Insurance payers will be
positively impacted with reduced claims to pay for preventable readmissions that may cost up
to 56% more than the treatment would have cost had the patient remained for resolution of the
acute care issue during the initial encounter (Alfandre, 2009). Public health and population
health may benefit from the full capturing of qualifying diagnoses that may be used to protect
our community’s and our nation’s health (CDC, 2024).
3. Evaluate how the proposed solution is unique or different from current care or
service delivery.
The only other home-based care model that helps to reduce readmissions is traditional home
health care(Amedisys, n.d.), which provides care in the patient’s home after they have been
discharged from the hospital but are not fully capable of self-care or require further therapy
training and monitoring (PSNet, 2021). The primary services offered through home health are
skilled nursing for services such as wound care, medication management, infusion therapy or
parenteral nutrition, and ostomy care (Johns Hopkins Medicine, n.d.). Therapy services may
include physical, occupational, or speech therapy. Other services may consist of periodic visits
from home health aides to assist with personal hygiene and social services to assist with
community resources.
However, all of these services (outside of private pay) are generally only covered by payers for
patients who have a skilled need (not acute needs) and qualify as “homebound” as defined by
the Centers for Medicare and Medicaid Services (CMS), meaning that the patient is unable to
3
Student ID # XXXXXX
D520: Healthcare Leadership and
Administration Capstone Task 3:
Business Plan
Reducing Readmission Rates Due to
AMA Discharges
,Create a business plan (suggested length of no more than 25 pages) for your proposed solution
from Task 2: Prospectus by doing the following:
A. Summarize the following points:
• the healthcare challenge or need
• your proposed innovative solution
Over the past sixty years, the rates of patients who go against medical advice to discharge
themselves (DAMA) from an inpatient hospitalization have increased (Haines et al., 2020). A
recent study showed that DAMA discharges account for over 338,000 inpatient
hospitalizations, with an average annual increase of 1.9% (Haines et al., 2020). The
consequences for a DAMA patient, leaving before their physician has completed treatment of
their acute care needs, can be dire, including a higher risk of 30-day readmissions (for
treatment of the same issue), repeat DAMA events, and worsening of their clinical condition
with a higher risk of death (Southern et al., 2012). DAMA events can lead to readmissions that
cost up to 56% more to treat than would be expected had the patient remained for the initial
hospitalization through to a physician-ordered discharge (Alfandre, 2009). A 2020 study found
that readmissions for patients who leave against medical advice accounted for more than
400,000 inpatient days, with a cost burden for healthcare of more than $800 million annually
(Tan et al., 2020).
The most common reasons that patients decide to leave before their acute care treatment is
completed, are related to personal or financial obligations (Haines et al., 2020). In my own
experience as both a former bedside registered nurse and now as an inpatient medical coder, I
daily see patients who are willing to risk their health and their lives to get home as the sole
caregiver of a dependent spouse, parent, or child. Other reasons may include the need to return
to work, or for others, once they feel better after their immediate acute needs are met, they see
no point in continuing treatment (Haines et al., 2020), such as additional days to complete an
entire course of IV antibiotics or continued observation of a condition that the physician feels
remains clinically unstable. Still others may object to the non-smoking campus, or they have
other addictions that override their willingness to stay for a complete course of treatment
(Alfandre, 2009).
A solution for hospital organizations to mitigate DAMA events is to meet the patient where
they are and offer (for patients who qualify) a patient-centered model that fuses home health
care and hospital-quality acute care that is delivered in the patient’s home. Acute care at home
(ACH) is a program that bridges the gap in care by providing the same clinical care,
medications, supplies, equipment, and services that the patient would have received as an
inpatient in the hospital setting. By caring for the patient at home, the patient will receive their
full course of treatment to resolve the acute issues during an initial encounter, while allowing
the patient to attend to their personal needs or obligations as tolerated without further risking
their health and potentially their lives.
By removing the barriers to remaining inpatient for care, an organization can better meet the
patient’s needs by largely reducing—or eliminating—the risk of readmissions (thereby
reducing the cost of healthcare delivery), improving the patient’s healthcare experience and
1
,satisfaction, and improving population health (including reduced mortalities), all of which
support an organization in meeting the triple aim of healthcare (Berwick et al., 2008).
B. Discuss your value proposition by doing the following:
1. Predict the anticipated benefits of the proposed solution in terms of health outcomes
and population health.
Health outcomes: Patients who leave as a DAMA discharge are leaving before treatment is
completed to fully resolve their acute care issues; this inadequate treatment can leave the acute
condition to progress into something more difficult to treat, prompting a readmission
(Alfandre, 2009). For example, if a patient with cellulitis due to an infected leg wound is
admitted for IV antibiotics, but decides to leave later the same day, he is greatly increasing the
risk of the untreated infection worsening and spreading, perhaps into his bloodstream (sepsis)
(Healthdirect, n.d.). What had been a localized infection requiring several days of IV
antibiotics is now a systemic infection and a medical emergency that will require readmission
to the hospital and treatment that may keep him longer than if he had stayed with the initial
admission (GlobalData Healthcare, 2024). Sepsis is a life-threatening complication from an
infection, and depending upon the patient’s age and co-morbidities, the risk of mortality may
be extremely high (GlobalData Healthcare, 2024). In fact, even for patients who have
recovered from sepsis, there remains a high probability that they will die within a short period
of time afterward, for some within two years (GlobalData Healthcare, 2024).
Had this same patient agreed to complete the prescribed treatment for his cellulitis, whether
inpatient, or through an acute care at home program, clinicians would have been able to
closely monitor the localized infection to ensure that it was fully treated without further
risking complications that may include life-threatening sepsis (PSNet, 2021). He would have
experienced a positive health outcome with the initial encounter without the added health risk
and financial burden of a readmission, as home care programs can reduce readmission rates,
shorten the length of treatment and costs, with fewer complications than the patient would
experience without adequate treatment (PSNet, 2021).
Population health: Public health departments, as well as other agencies such as the U.S.
Centers for Disease Control and Prevention (CDC), utilize science-based, data-driven
monitoring and tracking of diseases to protect our nation’s public health (CDC, 2024). County
public health data is used to inform a local community and individuals regarding diseases,
threats, or other underlying conditions that may impact our health (Maricopa County, n.d.).
When patients leave the hospital prematurely, reportable diseases that qualify as contagious,
severe, or frequent cannot be fully tracked; information that is impactful on population health
from national, state, and city sources (CDC, 2024) is then compromised or lost altogether.
By ensuring that acute care patients remain admitted for treatment, either inpatient or through
an acute care at home program, data collection is complete, may be reported to appropriate
agencies, and is available for the organization to identify health trends and needs within the
community it serves and develop strategies to meet these needs and improve its population’s
2
, health.
2. Explain how the key stakeholders identified in the prospectus could be impacted by
the proposed solution.
Internal: For patients, they may be positively impacted by an acute care at home program that
provides adequate clinical treatment of their acute care condition to support resolution of the
issue during an initial encounter, while reducing costs and the risk of readmission for the same
issue (PSNet, 2021). Care outside of the clinical setting also helps to reduce the patient’s risk
of exposure to hospital-acquired conditions, infections, or injuries. Clinical providers will
benefit in knowing that there is an alternative available (for patients who qualify)
(Professional Solutions, 2022) to reduce the risk of a readmission due to a worsening
condition, and this is especially true for emergency physicians and nurses, for whom
preventable return visits will not overburden an already busy department (Sartini et al., 2022).
With reduced incidence of readmissions, hospital administrators will experience less challenge
in managing the additional resources that are needed for a readmission, including bed
utilization, more labor time for clinical staff to assess the patient’s complications, and wasted
resources for care (diagnostics, medications, supplies) that would not have been required had
the patient remained for full treatment during the initial encounter (Alfandre, 2009).
External: The patient’s family or primary caregivers will be positively impacted as the patient
may be needed at home to assist with family matters or the care of a spouse, parent, or child.
They can feel reassured with less anxiety that their family member is still receiving the care
they need, even if they refuse inpatient care (Bressman et al., 2021). Insurance payers will be
positively impacted with reduced claims to pay for preventable readmissions that may cost up
to 56% more than the treatment would have cost had the patient remained for resolution of the
acute care issue during the initial encounter (Alfandre, 2009). Public health and population
health may benefit from the full capturing of qualifying diagnoses that may be used to protect
our community’s and our nation’s health (CDC, 2024).
3. Evaluate how the proposed solution is unique or different from current care or
service delivery.
The only other home-based care model that helps to reduce readmissions is traditional home
health care(Amedisys, n.d.), which provides care in the patient’s home after they have been
discharged from the hospital but are not fully capable of self-care or require further therapy
training and monitoring (PSNet, 2021). The primary services offered through home health are
skilled nursing for services such as wound care, medication management, infusion therapy or
parenteral nutrition, and ostomy care (Johns Hopkins Medicine, n.d.). Therapy services may
include physical, occupational, or speech therapy. Other services may consist of periodic visits
from home health aides to assist with personal hygiene and social services to assist with
community resources.
However, all of these services (outside of private pay) are generally only covered by payers for
patients who have a skilled need (not acute needs) and qualify as “homebound” as defined by
the Centers for Medicare and Medicaid Services (CMS), meaning that the patient is unable to
3
