The Care Transitions Project in Louisiana Demonstrates How Medicare Could Save Billions

Thursday, September 17, 2009 General News
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Fact Sheet

As of September 2009, The CMS Pilot Project to reduce avoidable readmissions in Louisiana has exceeded expectations. Within 6 months the readmissions rate has dropped from almost 19 percent to approximately 4 percent in the pilot population of patients receiving care transitions coaching, and the gains are holding.

If these results were replicated nationwide, the Medicare Payment Advisory Committee (MedPAC) estimates a potential savings to Medicare of over $12 billion. (1)

Project Background: Although potentially avoidable hospital readmissions is a national problem affecting 17.6 percent of all Medicare patients, the Commonwealth Fund reported in 2007 that Louisiana had the highest Medicare 30-day readmission rate in the country.(2) ( )

Within 30 days of discharge, 18.7 Medicare beneficiaries in the Baton Rouge metro area are re-hospitalized.(3)

Methodology: Recent studies by Coleman and Naylor suggest that interventions targeting comprehensive transitional care from the hospital to the community can reduce readmission rates by one-third.

Care Transitions Pilot interventions include one-on-one patient coaching and various discharge planning re-engineering steps to ensure that patients receive the proper after-care and follow-up.

Community-wide provider commitment:

Louisiana Care Transitions collaborative members:

More than ten home health agencies operating in the Baton Rouge area are also participating including:

Amedisys Home Health

Health Care Options

Feliciana Home Health

Pinnacle Home Health

Lane RMC Home Health

Delta Home Health

Pointe Coupee Homebound Health Services

Audubon Home Health.

Call Laurie Robinson, 225-926-6353, LHCR Director of Quality, for more information

Additional Resources:

(1) )A path to bundled payment around a rehospitalization: In Report to the congress: reforming the delivery system. Washington, DC: Medicare Payment Advisory Commission, June 2005:83-103 as referenced in New England Journal of Medicine, "Rehospitalizations among Patients in the Medicare Fee-for-Service Program," by Stephen F. Jencks, M.D., April 2nd, 2009

(2 )CMS Claims Data 10/08 - 3/08, CMS Data Warehouse, 1974 readmissions, 10565 discharges, Claims for beneficiaries in the target area (81 zips), all diagnoses

(3) )The Commonwealth Fund, State Scorecard Data Tables, June 2007, Supplement to Aiming Higher: Results from a State Scorecard on Health System Performance, Table 4.8

Committee on Finance news Release, April 28th, 2009, "Finance Leaders Release Health Care Reform Policy Options,"


"18 percent of hospitalizations of Medicare beneficiaries resulted in the readmission of patients who had been discharged within the last 30 days. . .."

CONTACT: Lisa Stansbury, Director of Communications of Louisiana Health Care Review, +1-225-248-7023

/PRNewswire-USNewswire -- Sept. 14/-- Of the Medicare beneficiaries who are readmitted within 30 days, 64 percent receive no post-acute care between discharge and readmission. -- Medicare patients report greater dissatisfaction in discharge-related care than in any other aspect of care measured by CMS.

SOURCE Louisiana Health Care Review

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