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Federal Program to Cut Hospital Readmissions Turns Out Modest Results


A new report has found that only a small number of groups included in a government-funded experiment to cut Medicare readmissions actually produced results. However, the less-than-hoped-for results don't necessarily indicate failure, a hospitalist and readmissions expert says.

The Community-based Care Transitions Program (CCTP) is one of several test care-delivery models created by the Affordable Care Act. Its main goal is to improve transitions of Medicare patients from the hospital to community-based settings, such as nursing homes, rehabilitation facilities, and government agencies that provide services to the elderly, and thereby reduce readmissions.

However, a new report [PDF] commissioned by the Centers for Medicare & Medicaid Services found that only four CCTP groups of the 48 studied significantly cut readmissions compared with those of a control group. The report was finished in May 2014 but wasn't made public until January.

"There are so few examples in healthcare where resource alignment makes sense with what we believe are the ideal ways of practicing," says Jeffrey L. Greenwald, MD, associate professor of medicine at Harvard Medical School and a member of the Inpatient Clinician Educator Service at Massachusetts General Hospital, both in Boston. "Things like CCTP, where you have an opportunity to partner a hospital with a community-based organization that can help to support patient transitions still looks promising despite its warts."

CCTP, funded with $300 million over five years, signed its first round of deals with community agencies in late 2011. The report covered partial 2012 results from groups participating in the early rounds.

Dr. Greenwald is one of the cofounders of SHM's Project BOOST, a yearlong QI program in which hospital teams are paired with mentors to help them improve care transitions. He explained that BOOST teams typically need at least 18-24 months to show positive results on length-of-stay or readmissions reductions.

"These are long processes that don't turn around overnight," Dr. Greenwald adds. "If they do, it's probably because [the hospital team] put in place something that is not sustainable, and the minute they stop measuring and keeping an eye on it, it will likely deteriorate.

"There's no magic bullet in care transitions."

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