CMS ramps up efforts to keep patients out of hospital

The Centers for Medicare & Medicaid Services made two announcements this week with the explicit goal of keeping patients out of the hospital.

One of the programs looks to keep patients from bouncing back after hospitalization. On Wednesday, CMS added 23 sites to its Community-based Care Transitions Program, aimed at preventing high-risk Medicare patients from being readmitted. Community-based organizations work with other providers to transition patients from the hospital to their homes, nursing homes or other facilities. As part of the two-year agreement, each participating organization will get a flat fee for coordinating care.

With this round of agreements, CMS has allocated half of the $500 million of the anticipated program spending over five years to the Community-based Care Transitions Program.

The newly added sites bring the total number of participants to 30 providers, including the seven announced in November. The program will support more than 126 local hospitals and help more than 223,000 Medicare beneficiaries in 19 states, according to CMS.  

"I've seen the very real difference that support from organizations like our partners in the Community-based Care Transitions Program can make to people's post-hospital care and their health," CMS Acting Administrator Marilyn Tavenner in the Wednesday announcement.

The other program that CMS touted this week similarly looks at coordinated care. CMS yesterday announced the $128 million Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.

CMS will partner with independent organizations to improve care for long-stay nursing facility residents on Medicare and Medicaid, facilitating transitions to and from inpatient hospitals and nursing homes. Each organization proposes evidence-based intervention and an improvement strategy, targeted at preventive services and improved communication between providers.

"Being readmitted to a hospital is very difficult for low-income seniors, people with disabilities and their families," Tavenner said in yesterday's statement. "Through this initiative, we will work with nursing facilities and hospitals to provide better, person-centered care. By catching and resolving issues early, we can help people avoid costly and stressful hospitalizations."

About 45 percent of hospital admissions of patients who receive Medicare skilled nursing facility or Medicaid nursing facility services could have been avoided, CMS said. That accounted for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005. 

For more information
- read the CMS announcement and program details on care transitions
- read the statement and program details on nursing homes

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.