Offering Three Months of Complimentary Transition Care Services to Prevent Avoidable Readmissions
Readmissions are both a financial and clinical problem. CMS began penalizing hospitals for 30-day readmissions in October 2012 (CHF, AMI, Pneumonia), with penalties ranging from 1 percent in 2012 to 2 percent in 2013. Stakes continue to get higher for hospitals as CMS plans to increase readmission penalties to 3 percent for fiscal year 2015. In addition to the increasing penalties, CMS is also adding other conditions such as total hip and knee replacements as well as chronic obstructive lung disease1.
South Florida is a unique community, and coming up with strategies to provide the most cost effective care is no different. In 2012, the SFHHA participated in the creation of the Greater Miami Coalition to Prevent Unnecessary Readmissions (GMCPUR). GMCPUR is a CMS backed demonstration project, which includes nine community hospitals and 5 post-acute care providers. This coalition has successfully decreased readmissions rates to about 14% for the beneficiaries that participate in the program. As this program sets to expire in 2014*, SFHHA reached out to one of its members, Transition Care of America, in order to continue these services and expand it to all its member hospitals in the tri-county area. “Even though such services could incur a minimal cost to hospitals at the end of the trial period, the patients and hospitals will find it a cost effective alternative to readmission,” said Linda Quick, president of the SFHHA.
Transition Care of America, once a division of Specialized Nursing Services (SNS), has provided transition care services since 2012. SNS is one of the founding agencies participating in the GMCPUR CMS demonstration project in Miami-Dade County. As the need for these services increased, SNS created an independent company, Transition Care of America, to specialize in post-acute care management services, in specific, transition care services to prevent readmissions. In addition to the Miami-Dade project, TCA has been very successful in two Broward area hospitals. TCA maintains a 12% readmission rate for those patients these hospitals identified as ‘high risk’ for readmission. TCA currently provides these services for all payers, including the uninsured, and all conditions.
As we move closer to 2015, the impending increase in CMS readmission penalties becomes a reality for our area hospitals. SFHHA has negotiated a deal with TCA offering three months of complimentary transition care services exclusively for its members. Linda Quick, is excited about the partnership. “We thought this was an interesting proposal for our members. Helping them prevent readmissions to avoid federal government penalties and reduce costs is crucial. We believe in the transitional care model, and case management services TCA offers. This is something that will benefit both our members and their patients.”
