Medicare – Eliminating Unnecessary Hospital Visits

Medicare is looking for a way to create more seamless transitions from the hospital to home, skilled nursing care, or home health care. These transitions include helping te patients stay well enough that they don’t have to return to the hospital.

For years, it has been said that most people who are readmitted into the hospital do not have to be – more often than not – they should be able to go home (or to a skilled nursing care facility), and with the proper care, they should be able to stay home and progress. The Centers of Medicare & Medicaid Services has collected a great deal of data that indicates that many hospital readmissions of Medicare patients are preventable and the agency announced a program in 14 communities aimed at eliminating these “unnecessary” hospital readmissions.

The Care Transitions Project has been created by CMS to improve health care processes so that patients, their caregivers, and their entire team of providers have what they need to keep patients from returning to the hospital for ongoing care needs, according to CMS.

There are several important components to keeping a individual from returning to the hospital. Two of the most important components are having excellent home care to help the patient stay healthy. Bcing up and coupling this type of care with regular follw-up visits with the doctor will ensure that the patient’s health will improve.

The total cost of unplanned hospital readmissions exceeds $17 billion annually, and varies widely across states. One of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, according to a Commonwealth Fund-supported study in the New England Journal of Medicine.

By promoting seamless transitions from the hospital to home, skilled nursing care, or home health care, this community-wide approach seeks, not only to reduce hospital readmissions but to yield sustainable and replicable strategies that achieve high-value health care for Medicare beneficiaries

“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 health care quality from a community-wide perspective, and focusing on how all of the members of an area’s health care team can better work together in the best interests of their shared patient population.”

CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Re-admission rates for hospitals have been tracked by CMS for some time, and will be available to consumers later this year through the Hospital Compare Web site at

“The Care Transitions Project is a new approach for CMS,” added Barry M. Straube, M.D., chief medical officer for CMS and its Office of Clinical Standards & Quality director.

“Rather than focusing on one global problem and trying to apply a one-size-fits-all solution 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 New Jersey;
Metro Atlanta East, Ga.;
Miami, Fl;
Tuscaloosa, Ala.;
Evansville, Ind.;
Greater Lansing Area, Mich.;
Omaha, Neb.;
Baton Rouge, La.;
North West Denver, Colo.;
Harlingen, Texas; and
Whatcom County, Wash.

The work of the Care Transitions Project will respond to the unique needs of each of the 14 communities, says CMS.

Each of the CTP communities is led by a state Quality Improvement Organization (QIO). QIOs work throughout the country as part of CMS’s quality program to help health care providers, consumers and stakeholder groups to refine care delivery systems to make sure all Medicare beneficiaries get the high-quality, high-value health care they deserve.

Each QIO in the project is required to work with partners to implement the following:

a) Hospital and community system-wide interventions;

b) Interventions that target specific diseases or conditions; and

c) Interventions that target specific reasons for admission.

The following QIOs serve as Care Transitions leaders throughout the country:

Quality Partners of Rhode Island;
IPRO Inc. (in New York);
Quality Insights of Pennsylvania;
Healthcare Quality Strategies Inc. (in New Jersey);
Georgia Medical Care Foundation Inc.;
FMQAI (in Florida); AQAF (in Alabama);
Health Care Excel (in Indiana);
MPRO (in Michigan);
CIMRO of Nebraska;
Louisiana Health Care Review;
Colorado Foundation for Medical Care;
TMF Health Quality Institute (in Texas); and
Qualis Health (in Washington).

The Care Transitions Project will continue in all 14 communities through summer 2011. For more information about the Care Transitions Project, visit To learn more about the work that QIOs are doing across the country, visit

3 Responses to Medicare – Eliminating Unnecessary Hospital Visits

  • jane deale says:

    We would to be part of your study, since all the July 1 changes came about things have changed alot. Especially for those home health agencies like our that do not limit the patient visits. We are truly passionate in helping the patient achieve a higher quality of life at home, where they want to be. We also provide the most professional health care workers, that communicate with the referring physicians and ensure patients are going to their follow up appoints. Please tell me what we can do to start this pilot program here in Florida.

  • as many as one million treatment recipients will have to choose brand new coverage, depending on AARP….for all those with conventional Medicare, the most significant change on the horizon is a expansion with benefits. beginning Jan. 1, Medicare should completely cover the cost of many [preventive] companies, including mammograms, Pap studies and tests for prostrate and intestines cancer, in addition to one 12-monthly ‘wellness’ visit

  • mahesh babu says:

    while going thru your web log,i obtained what info i require,thank you

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