NAHQ Certified Professional in Healthcare Quality Examination CPHQ Question # 237 Topic 24 Discussion
CPHQ Exam Topic 24 Question 237 Discussion:
Question #: 237
Topic #: 24
An organization’s 30-day readmission rate for heart failure patients is at the upper limit of the acceptable range for CMS. What is the appropriate step for evaluation of this rate?
A.
Utilize the case management team to review all readmissions and share patterns and trends with the medical staff to identify ways to reduce the rate further.
B.
Encourage the nursing staff to improve communication with patients and families to ensure patients have durable medical equipment at discharge.
C.
Convene an interdisciplinary group to review current activities to ensure sustainability for minimizing CMS payment reduction in the future.
D.
Have the quality department monitor the rate for the next six months and, if the rate exceeds the upper limit, begin an analysis of the cases.
Within the Population Health and Care Transitions domain, NAHQ guidance stresses proactive evaluation of high-risk performance measures, especially those tied to CMS payment programs. When a metric is at the upper limit of acceptability, the organization should not wait for performance to worsen.
Convening an interdisciplinary group allows the organization to assess whether existing interventions are effective and sustainable, and to identify opportunities for strengthening care transitions, patient education, and follow-up processes. This proactive approach supports long-term performance stability and minimizes future financial penalties.
Waiting for performance to exceed thresholds (Option D) reflects reactive management. Options A and B represent specific interventions that should only occur after a broader evaluation confirms gaps. NAHQ emphasizes sustainability and cross-functional accountability, making Option C the correct choice.
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