Almost one in five patients discharged from a hospital in the United States -- 19.6 percent -- are readmitted within 30 days. As hospitals shorten lengths of stay and care becomes more fragmented, the process by which patients move from hospitals to other care settings is increasingly problematic. Medicare patients report greater dissatisfaction related to discharges than to any other aspect of care that CMS measures.
Addressing this challenge requires improved coordination across health care settings and empowering Medicare patients to take a more active role in managing their own health. Previous Medicare care transitions projects have successfully reduced avoidable readmissions by focusing on the entire continuum of care, and including the patient.
As the Medicare Quality Improvement Organization for Missouri, Primaris will partner with important representatives of healthcare and general community settings to reduce avoidable readmissions. An avoidable readmission is one clinically related to a prior admission, if there was a reasonable expectation that it could have been prevented by:
- Providing quality care during the patient's first hospital stay
- Adequately planning the patient's discharge
- Improving coordination between inpatient and outpatient care teams
In Fiscal Year 2012, inpatient prospective payments to hospitals will be reduced based on the dollar value of the hospital's percentage of preventable Medicare readmissions related to heart failure, acute myocardial infarction and pneumonia.
Primaris' goals:
- Ensure a community-wide impact on improving care transition for Medicare patients
- Drive sustainable changes in care from a community perspective
- Assist healthcare communities with root-cause analysis, evidence-based interventions for care transitions and applying to the national Community Based Care Transition Program
- Create Learning and Action Networks for Care Transitions (more information to come)
Learn more about the Centers for Medicare & Medicaid's Community Base Care Transition program.
QIOs are tremendous allies in the effort to reduce avoidable hospital readmissions. A recent QIO Program initiative that involved 14 communities nationwide reduced admissions per 1,000 beneficiaries by 5.6%, compared with a 3.4% reduction in 52 peer communities
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Care Transitions Project - An Overview