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CMW sneak peek: How CMS' 9th Scope of Work will affect readmissions

Case Management Weekly, August 26, 2009

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There’s been a lot of buzz recently surrounding possible regulations restricting payments to hospitals for readmissions within 30 days of discharge. Many experts say it’s only a matter of time before there is legislation reducing or eliminating reimbursement to hospitals for preventable readmissions.

Case Management Monthly discussed this topic with several experts who have been involved in this issue since CMS first started working with it through the 9th Scope of Work; CMS continues to study it as the Transitions of Care pilot project. Among these experts were Alicia Goroski, MPH, the project director for the Care Transitions Quality Improvement Organization (QIO) support contractor at the Colorado Foundation for Medical Care, and Doug Brown, BS, MHS, the government task lead for the Care Transitions Theme.

Q. What is the basic background of CMS’ 9th Scope of Work?
AG: The 9th Statement/Scope of Work started on August 1, 2008. The Care Transitions Theme was a subnational theme, which means it was competitively bid and not awarded to every state. There were 14 QIOs, or 14 states, selected to participate in this project. For the project, the participating QIOs defined a community based on a set of ZIP codes.

One of the overall goals of this project is to reduce the 30-day readmission rate for Medicare beneficiaries residing in the identified ZIP codes.

There are more measures to this project than simply reducing 30-day hospital readmissions. We’re also looking at patient satisfaction using four of the questions from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

DB: One of the outcome measures at the 28-month mark is to evaluate whether the QIO’s work has had an effect on patient satisfaction. To do this, we have two measures. One looks at medication management and the other at discharge planning and whether the patient felt the hospital addressed his or her needs.

Check out the August 2009 issue of Case Management Monthly to read the full article, and discover the benefits of becoming a Case Management Monthly subscriber.

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