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Medicare reform illusion or quality improvement opportunity?

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By Gary Curtis, MSW

Without getting into what is clearly a partisan debate about whether or not the health care reform will reduce costs, it is important to mention that components of the bill do address quality improvements that are meant to drive down costs. 

In response to “The Medicare reform illusion,” August 27, 2010, The Washington Post, what Mr. Leavitt fails to mention is that at least two of the initiatives embedded in the PPACA are described as  the hospital readmissions reduction program (Sec. 3025) and the Community-Based Care Transitions program that are expected to reduce avoidable readmissions to hospitals.  The cost of Community Based Care Transitions Programs in the PPACA is only $500 million for community-based organizations [Sec. 3026, p. 295].  The estimated cost savings to Medicare is $12 billion per year.   

Our work with the CMS Care Transitions Pilot Program has revealed that significant reductions in avoidable hospitalizations are achievable by engineering an efficiency among those patients who were “coached” through the discharge process.  Our first patient was coached in March 2009. Since that time, 239 patients have completed the coaching intervention. Of those 239 patients, only 17 have been readmitted within 30 days, which makes our project to date readmission rate for the coached population of only 7% versus the expected community rate of 21.3%. 

Quality of care is improved because patients are healthier and avoiding a hospital readmission that puts them at  risk of infections, the health care system wins through better coordination among all parties and we all win when the Medicare Trust Fund benefits.


The Remington Report article link on current coaching project success http://louisianaqio.eqhs.org/PDF/Care%20Transitions/RemingtonReport.pdf

Additional information is available here:   http://www.nytimes.com/2009/04/02/health/02hospital.html?_r=2

“CMS Awards Contracts for Quality Improvement Organizations’ 9th Statement of Work,” Fact Sheet, Centers for Medicare & Medicaid Services, August 2008.  www.cms.hhs.gov/QualityImprovementOrgs/downloads/9thSOWAnnouncement080508.pdf

Medicare Payment Advisory Commission, 2008, Report to the Congress: Reforming the Delivery System.  Washington, DC: Medicare Payment Advisory Commission, p87. http://www.caretransitions.org/documents/Evidence_and_Adoptions_2.pdf

See also in Patient Protection and Affordable Care Act SEC. 2717. ENSURING THE QUALITY OF CARE….The Secretary shall…‘‘(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling.

Permanent link to this article: http://www.eqhssmarterhealthcare.org/medicare-reform-quality-improvement-opportunity/

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