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The government is beginning the third year of fining hospitals for having too many readmissions of patients with Medicare, and penalties, as well as the categories of patients included in the data measured, are increasing. The goal is to encourage healthcare systems and care providers within them to manage chronic disease better. The problem is a complex one. Safety-net hospitals, which tend to have sicker patients with less resources, may not be able to meet the same bench marks that hospitals catering to the wealthy can. However, to set a lower goal for these hospitals would be tantamount to the government enforcing a lower standard of care for the poor. In addition, managing chronic disease to reduce readmission will reduce overall admissions, and some hospitals cannot remain financially stable if they do so. The article was produced for Kaiser Health News (KHN) in association with the Scan Foundation, whose stated mission is to promote aging with dignity and independence. It relates to another story published on KHS about a hospital system who has hired a nurse just to talk with people about their diabetes in an effort to promote patient self-care and knowledge, and reduce hospital admissions (McCammon, 2014). Reference McCammon, S. (2014). Personal attention seen as antidote to rising health costs. Georgia Public Radio & Kaiser Health News. Retrieved from http://kaiserhealthnews.org/news/care-coordinators-try-to-save-hospitals-money/

Erin, such a telling article and relates to the complexity of the entire process of self care, desire to change, and personal empowerment. Knowledge skills and attitudes are at the core of some of the issues but one also has to consider the socio-cultural-economic environment as well. Identifying those who are at the highest risk for readmission based on multiple inputs may be the next step--both for financial relief for hospital and improved outcomes for patients.

This article is a useful example of a complex adaptive system. From a personal business perspective, the author discusses several reasons as to why the implementation of The Affordable Care Act has been challenging. This example of a macro system exhibits the need for multiple aspects within the system to work in collaboration with key stakeholders including government parties, insurance companies, business and individuals. Seib, G. (2013). Why new health law is so complicated. The Wall Street Journal. Retrieved from http://online.wsj.com/articles/SB10001424052702303755504579205800232065892

This article also provides insight into how the macro, micro and meso systems become so intertwined in such a large undertaking and how its implementation philosophically is even more complex as it advances both parties polar opposite desires of privatization and unification of health care delivery. Great short read!