CMSA Today - Issue 2, 2011 - (Page 14)

Cover Story The ACA and You Case Managers Are Key Players in Enhanced Coordinated Care Under the New Law BY JANE BROCK, MD, MSPH & LAURA MANKIN, BS In 2001, the Institute of Medicine issued a report that called for increased care coordination across the health care system to improve quality of care and reduce errors. T en years later, we are on the verge of finally acting on these recommendations on a very large scale. Few people doubt that the new environment created by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) will directly affect the daily work of case managers, especially those working in hospitals. Although it is somewhat discouraging that increased care coordination took 10 years to arrive at a tipping point, it is worth noting that a number of key features have been put into place during that time that have created a dramatically different set of opportunities for today’s practitioners. First, we have a much better understanding of the role of care coordination and new definitions for what we really want – which is intentionally effective transitional care. Although we talk quite commonly about transitional care, it was a term rarely used, and not explicitly defined, 10 years ago. Second, we have very good numerical indicators of the magnitude of the problem that lack of transitional care contributed to – take, for example, the often-cited statistic from a 2009 edition of The New England Journal of Medicine that nearly 20 percent of all Medicare beneficiaries discharged from hospitals are readmitted within 30 days (Jencks, SJ et al.). Third, we have good estimates of the cost of not providing well defined and well coordinated transitional care, which according to a 2007 report to Congress is at least $15 billion per year; read that again: $15 billion. Although cost may not be as important a consideration as the goal of improving patient outcomes, framing that cost has been crucial to finally assigning the appropriate level of urgency to the issue. Fourth, and most important, is that all the above resulted in the ACA, which has established a clear mandate for transitional care, and the economic means to deliver it. (See the URL in the references at the end of this article for a PDF of the law.) DEFINING TRANSITIONAL CARE Transitional care is defined by the American Geriatrics Society as “a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location.” The ACA has six sections that directly support payment modification based on implementing transitional care activities or reducing hospital 14 CMSA TODAY Issue 2 • 2011

Table of Contents for the Digital Edition of CMSA Today - Issue 2, 2011

CMSA Today - Issue 2, 2011
Table of Contents
Outgoing President’s Letter
Incoming President’s Letter
How Care Coordination Affects You
Demonstrating Case Management’s Value to Hospitals’ Bottom Line
Making the Case for Evidence-Based Case Management Practice and Programs
Association News
Ask the Expert
Facility Profile
View From Capitol Hill
Case Management and the Law
Ethics Casebook
Mentoring Matters
Index of Advertisers

CMSA Today - Issue 2, 2011