CMS launches pilot program to curb hospital readmissions

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The Centers for Medicare & Medicaid Services (CMS) has chosen 14 communities across the United States to participate in Care Transitions Project, the goal of which is to eliminate unnecessary hospital readmissions.

"Our data show that nearly one in five patients who leave the hospital today will be re-admitted within the next month, and that more than three-quarters of these re-admissions are potentially preventable," said CMS Acting Administrator Charlene Frizzera. "This situation can be changed by approaching healthcare quality from a community-wide perspective, and focusing on how all of the members of an area's healthcare team can better work together in the best interests of their shared patient population."

The goal of the Care Transitions Project is to improve healthcare processes so that patients, their caregivers and the entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs, the agency said. By promoting transitions from the hospital to home, skilled nursing care, or home healthcare, the community-wide approach seeks, not only to reduce hospital readmissions but to yield replicable strategies that achieve healthcare for Medicare beneficiaries

"The Care Transitions Project is a new approach for CMS," said Barry M. Straube, MD, chief medical officer for CMS and its office of clinical standards and quality director.  "Rather than focusing on one global problem and trying to apply a one-size-fits-all soution across the country, Care Transitions experts will look in their own backyards to learn why hospital re-admissions occur locally and how patients transition between health care settings. Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of re-admissions."

Communities in the following regions have been selected to participate in the project: Providence, R.I.; Upper Capitol Region, N.Y.; Western Pennsylvania; Southwestern N. J.; Metro Atlanta East, Ga.; Miami.; Tuscaloosa, Ala.; Evansville, Ind.; Greater Lansing Area, Mich.; Omaha, Neb.; Baton Rouge, La.; North West Denver, Colo.; Harlingen, Texas; and Whatcom County, Wash. 

Each of the Care Transitions communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS's quality program to help healthcare providers, consumers and stakeholder groups to refine care delivery systems to make sure all Medicare beneficiaries get proper healthcare.  

Each QIO in the project is required to work with partners to implement the following: hospital and community system-wide interventions; interventions that target specific diseases or conditions; and interventions that target reasons for admission.

The following QIOs serve as Care Transitions leaders throughout the country: Quality Partners in R.I.; IPRO in N.Y.; Quality Insights of Pa.; Healthcare Quality Strategies in N.J.; Georgia Medical Care Foundation; FMQAI in Fla.; AQAF in Ala.; Health Care Excel in Ind.; MPRO in Mich.; CIMRO of Neb.; Louisiana Health Care Review; Colorado Foundation for Medical Care; TMF Health Quality Institute in Texas; and Qualis Health in Wash.

CMS said it will monitor the success of this project by watching the rates at which patients in the communities return to the hospital.