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CMS pilot attacks unnecessary rehospitalization

May 1, 2009
by root
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Noting that one in five Medicare patients are rehospitalized after discharge, and three-fourths of these cases could be avoided, the Centers for Medicare & Medicaid Services (CMS) has developed a quality improvement program addressing this. Using Quality Improvement Organizations (QIOs) in 14 states, the Care Transitions Program encourages providers from skilled nursing facilities, hospitals, and home health agencies to track rehospitalizations and their causes and to collaborate on solutions. “This is not a regulatory model,” emphasized Dr. Paul McGann, CMS deputy chief medical officer. “It is a collaborative effort involving providers at the local level addressing local situations.” Interventions will target specific diseases or conditions and specific reasons for hospital admission. The 14 communities involved in the pilot program, slated to continue through summer 2011, include Providence, Rhode Island; Upper Capitol Region, New York; Western Pennsylvania; Southwestern New Jersey; Metro Atlanta East, Georgia; Miami, Florida; Tuscaloosa, Alabama; Evansville, Indiana; Greater Lansing Area, Michigan; Omaha, Nebraska; Baton Rouge, Louisiana; North West Denver, Colorado; Harlingen, Texas; and Whatcom County, Washington. Rehospitalization rates in these areas will be made available to consumers later this year at the Hospital Compare Web site. For more information, visit http://www.cfmc.org/caretransitions/.

Joint Commission recognized as continued hospice deeming authority

The Centers for Medicare & Medicaid Services (CMS) has renewed The Joint Commission's deeming authority for hospice organizations, receiving the full six-year term allowed by law.

Hospice organizations accredited by The Joint Commission, which has been granting deemed authority for hospice since 1999, will be seen as meeting Medicare and Medicaid certification requirements. Those accredited through the voluntary program are considered eligible for Medicare reimbursement.

“CMS found that The Joint Commission's standards for hospice meet or exceed those established for the Medicare and Medicaid programs,” The Joint Commission said in a statement. “According to the Hospice Association of America's 2008 Hospice Facts and Statistics report, Medicare-certified hospices have grown from just 31 in 1984 to more than 3,000 in January 2008, serving more than 950,000 patients annually.”

The Joint Commission's accreditation, unlike federal deemed status, may be recognized by some states' quality oversight activities. The following states recently accepted Joint Commission home care accreditation for licensure requirements for hospice: Arizona, Georgia, Iowa, Montana, Nebraska, New Jersey, Ohio, Oregon, Tennessee, Texas, Utah, Virginia, Washington, Wisconsin, and Wyoming.

Organizations seeking Medicare approval may choose to be surveyed either by an accrediting organization such as The Joint Commission, or by a state survey agency on behalf of CMS-acquiring deemed status is not a requirement. Deemed status surveys are unannounced and organizations with that option are evaluated to determine compliance with applicable Joint Commission hospice standards.

A quick reference guide from The Joint Commission to understanding the hospice deemed status option is available at http://www.ltlmagazine.com/DeemedStatusGuide.

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