Health Leaders Media – April 13, 2009.

CMS today announced the 14 communities around the nation that have been picked for its three-year pilot project to eliminate unnecessary hospital readmissions that cost Medicare billions of dollars annually in preventable care.

A study published this month in the New England Journal of Medicine found that nearly 20% of Medicare patients in 2003-2004 were back in the hospital within 30 days of a discharge, and that 34% were rehospitalized within 90 days. The study estimated the cost of the unplanned rehospitalizations in 2004 at $17.4 billion.

“Our data show that nearly one in five patients who leave the hospital today will be readmitted within the next month, and that more than three-quarters of these readmissions are potentially preventable,” CMS Acting Administrator Charlene Frizzera says. Click title to read more…

“This situation can be changed by approaching health care quality from a community wide perspective, and focusing on how all of the members of an area’s health care team can better work together in the best interests of their shared patient population.”

The Care Transitions Project sites will operate in: Providence, RI; Upper Capitol Region, NY; Western Pennsylvania; Southwestern New Jersey; Metro Atlanta East, GA; Miami; Tuscaloosa, AL; Evansville, IN; Greater Lansing Area, MI; Omaha, NE; Baton Rouge; North West Denver, CO; Harlingen, TX; and Whatcom County, WA.

The Care Transitions Project will continue in all 14 communities through summer 2011.

CMS says the pilot project is designed to improve healthcare processes so that patients and caregivers have the tools, training, and procedures the need to reduce unnecessary readmissions. The program will promote “seamless transitions” from the hospital to the home, skilled nursing facility, or home healthcare.

While hospitals have been supportive of the idea of reducing hospital readmissions, many executives are concerned about a CMS plan to reduce reimbursements for hospitals with high readmission rates. Ed Hannon, CEO of McDowell Hospital in Marion, NC, and president of the American Hospital Association’s Small or Rural Hospitals Governing Council, says that many readmissions are beyond the control of hospitals. He says that smaller hospitals with lower patient volumes could be particularly hard hit if only a handful of patients are readmitted.

Hannon told Congress last month that the effort to save about $8 billion by trimming payments to hospitals with high 30-day readmission rates may be a one-size-fits-all solution to a complex series of problems. “Any provision that does not recognize legitimate reasons for readmission may become an obstacle to patient care and safety,” he says.

Barry M. Straube, MD, CMO for CMS, says the pilot project will look at the particular needs and resources in each of the 14 communities. “Rather than focusing on one global problem and trying to apply a one-size-fits-all solution across the country, Care Transitions experts will look in their own backyards to learn why hospital re-admissions occur locally and how patients transition between health care settings,” says Straube, who is also director of CMS’ Office of Clinical Standards & Quality. “Based on this community-level knowledge, Care Transitions teams will design customized solutions that address the underlying local drivers of readmissions.”

CMS will monitor the success of this project by watching the rates at which patients in these communities return to the hospital. Readmission rates for hospitals have been tracked by CMS for some time, and will be available to consumers later this year through the Hospital Compare Web site at www.hospitalcompare.hhs.gov.

Each of the 14 communities is led by a state Quality Improvement Organization whose job is to refine care delivery systems. The QIOs are: Quality Partners of Rhode Island; IPRO Inc. (in New York); Quality Insights of Pennsylvania; Healthcare Quality Strategies Inc. (in New Jersey); Georgia Medical Care Foundation Inc.; FMQAI (in Florida); AQAF (in Alabama); Health Care Excel (in Indiana); MPRO (in Michigan); CIMRO of Nebraska; Louisiana Health Care Review; Colorado Foundation for Medical Care; TMF Health Quality Institute (in Texas); and Qualis Health (in Washington).

John Commins is an editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.