Reluctant hospitals slowly join community-based care

When the Centers for Medicare & Medicaid Services launched the Community-Based Care Transitions Program last year, it didn't seem fair to some skeptical hospital leaders, who noted the project  funds community-based organizations but hits hospitals with readmission penalties. 

Although the program, which focuses on care transitions between inpatient and outpatient settings, has had a slow start, CMS reports 47 organizations--some of which are hospitals--are participating in the $500 million program.

Under the Affordable Care Act, the Community-Based Care Transitions Program tests models to reduce readmissions for high-risk Medicare patients from the inpatient hospital setting to other care settings. Community-based organizations get an all-inclusive rate per eligible discharge, based on the cost of transition services provided at the patient level and hospital level. CBOs only are paid once per eligible discharge in a 180-day period of time for any given beneficiary, CMS explained.

"The fundamental flaw in this model is that hospitals are the only entity eligible to be penalized for readmissions, yet hospitals are not eligible to directly receive any of the technical assistance funds available," Lisa Grabert, American Hospital Association senior associate director for policy told HealthLeaders Media.

Similarly, Atul Grover, Association of American Medical Colleges chief policy officer, told Kaiser Health News and Colorado Public Radio that it's unfair to tie hospitals' payments to what kind of healthcare their patients get after they've been discharged.

"That quite frankly needs to be a shared responsibility," he said. "It's not just the responsibility of the hospital, and yet you're putting the entire financial burden and expectation on an inpatient setting."

However, hospitals can lead the effort to curb readmissions inside their doors and out, according to Harlan Krumholz, a professor at the Yale School of Medicine.

"You have to look at the hospitals and say, 'You've got this extra burden because you are the central organizing force for healthcare in most communities in the nation. You get more revenue than anyone else. And with that position comes great responsibility,'" Krumholz told KHN and CPR.

It's still early to tell whether program is working, but for the few hospitals up to the challenge, it's worth it, according to Christopher Shearer, chief medical officer for the John C. Lincoln North Mountain Hospital based in Phoenix.

In "a worst-case scenario--even if it doesn't work--we won't have lost anything," he told HealthLeaders.

For more information:
- see the HealthLeaders Media article
- here's the KHN and CPR article
- check out the CMS website

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