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Anthony Cirillo

Bill Would Provide Payment for Transitional Care Initiatives

By December 3, 2012

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Legislators have introduced the "Medicare Transitional Care Act of 2012" aimed to aid patient transitions from one care setting to another within the health care system. The bill would have Medicare give a specific payment -- based on performance metrics and improved outcomes -- to providers performing coordination activities. The legislation was sponsored by Reps. Earl Blumenauer (D-OR), Thomas Petri (R-WI), Allyson Schwartz (D-PA) and Jan Schakowsky (D-IL).

The legislation is intended to improve patient health outcomes, reduce hospital readmissions, and save healthcare resources.

Cited in the legislative announcement is a study published in April 2009 in the New England Journal of Medicine that found that almost one third of Medicare beneficiaries studied who were discharged from a hospital were re-hospitalized within 90 days. Additionally, one-half of the individuals re-hospitalized had not visited a physician since their discharge, suggesting a lack of follow-up care. The study estimated that Medicare spent $17.4 billion in 2004 on unplanned re-hospitalizations.

In its June 2012 Report, Medicare Payment Advisory Commission, MedPAC, highlighted the need for an explicit payment for transitional care services, given the documented evidence that effective and coordinated care transitions improve health outcomes, reduce readmission rates, and generate significant savings to the U.S. health care system. The Congressional Budget Office has echoed these findings. In a report documenting lessons from Medicare's demonstration projects, the CBO emphasized that`programs that smoothed transitions (for example, by providing additional education and support to patients moving from a hospital to a nursing facility or between a primary care provider and a specialist) tended to have fewer hospital admissions.''

Providing a transitional care benefit within Medicare will help coordinate care, develop a care plan for patients and their caregivers, identify potential health risks, and prevent unnecessary hospitalizations.

This legislation comes as hospitals prepare to face penalties for failing to prevent readmissions for conditions such as pneumonia and heart failure. The penalties went into effect Oct. 1 and emphasize the need for long-term care providers to work more closely with hospitals.

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