CMSA Today - Issue 5, 2013 - (Page 12)

Transitions Working to Improve Transitions of Care P atients and their caregivers frequently find themselves trying to understand health care information and the process of transitions of care. They often struggle with how to communicate with providers, health care agencies, and insurance payers about the various treatment and care options available to them. In fact, they may not even know what questions to ask. Transitions of care are difficult, confusing, complicated and complex for most consumers and often are a challenge for providers. Transition of care is defined as the movement of patients from one level of care to another as their condition and care needs change.1 Transitions occur in every stage of the health care continuum, from the PCP to the specialist; hospital to home; hospital to outpatient services; an ER hospital setting to ICU; the skilled nursing facility to home; and home to hospice. For the patient, each transition requires communication from the referring provider, the sender, to the next level of care provider, the receiver. To achieve the most positive outcomes, the patient and his or her caregiver should be part of this communication process. Unfortunately, this communication and exchange of information does not occur on a consistent basis. In 2010, the Patient Protection and Affordable Care Act (PPACA) set the stage for reform in the U.S. health care system. Many of the provisions in this act highlighted the need for improved transitions of care and care coordination. PPACA also identified the need to reduce avoidable hospital readmissions. To support this need, in 2012, the Centers for Medicare and Medicaid Services (CMS) implemented hospital penalties when hospitals 12 CMSA TODAY had an unacceptable hospital readmission rate. Studies such as the “Rehospitalization Among Patients in the Medicare Fee-for-Service” Program highlighted several of these readmission concerns.2 The study completed an analysis of Medicare Claims data from BY CHERI LATTIMER, RN, BSN 2003-2004 and looked at 11,855,702 Medicare beneficiaries discharged from the hospital during that time period. Some of the findings were: — 19.6 percent (nearly 1/5) were rehospitalized within 30 days — 34 percent were rehospitalized within 90 days — 50.2 percent of those rehospitalized within 30 days after a medical discharge had no bill for a visit to a physician office REHOSPITALIZATION Does encouraging older patients and their caregivers to assert a more active SOURCE: Jencks, SF, Williams MV, EA Coleman, EA. (2009). Rehospitalizations among patients in the Medicare fee-for-service program. New England Journal of Medicine, 360 (14): 1418-1428 Issue 5 • 2013 • DIGITAL

Table of Contents for the Digital Edition of CMSA Today - Issue 5, 2013

The Wonderful Side of Transitions
Working to Improve Transitions of Care
CMSA & Public Policy
Association News
CMSA’s 23rd Annual Conference & Expo
CMSA Corporate Partners
Index of Advertisers

CMSA Today - Issue 5, 2013