Do You Factor Transitional Care into Medicare Value-Based Reimbursement?

Tuesday, April 8th, 2014
This post was written by Patricia Donovan

There is a wealth of assistance available to avoid hospital readmissions penalties.

In the suite of performance-based measurement that currently comprises Medicare reimbursement, a big component of value-based purchasing relates to transitional care, as well to the readmission penalty program, notes Amy Boutwell, MD, MPP, president of Collaborative Healthcare Strategies and a co-founder of the IHI STAAR (State Action on Avoidable Rehospitalizations) Initiative, Dr. Boutwell is also senior physician consultant to the National Coordinating Center for the CMS QIO Care Transitions Theme.

All of these elements factor into your Medicare reimbursement over the next several years. The good news is that along with these penalties and performance-based value purchasing strategies, there is a wealth of technical assistance available to hospitals and community-based teams trying to improve care transitions. There are literally hundreds of millions of dollars in technical assistance that has been funded by CMS and the Administration on Aging to help hospitals and community-based partners such as area Agencies on Aging and others work together to improve care transitions to reduce readmissions.

Many of you are very familiar with the Hospital Engagement Networks. I want to remind you that the Quality Improvement Organizations (QIOs), of which there is one in every state, have been charged through their contracts to help communities. Groupings of hospitals and of post-acute providers in regional geographies help to improve care transitions and care coordination across settings. Take advantage of the wealth of other programs and incentives that are coming out of the federal government in this domain.

We know the readmission penalties are here to stay and there will be time lines between your good efforts at the pilot level today and your ability to see those numbers move in terms of getting your hospital out of the penalty zone. In my experience, we do need to move quickly from pilot projects to a portfolio of work to help make some traction on readmission performance for hospitals. I always go back to the STate Action on Avoidable Rehospitalizations (STAAR) initiative, which I co-founded. Its how-to guide to reducing hospital readmissions is the broadest stroke guidebook that is out there.

Some toolkits have a very fine level of detail, which is very helpful; the STAAR toolkit contains broad concepts. I hope it is helpful to teams. These days, I’m seeing hospitals take good ideas from everywhere and put them together into one strategy based on their own resources and cross analysis.

Excerpted from 33 Metrics for Care Transition Management.

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