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  • MRRP – MediCaring.org
    based readmissions programs We do not know at this point whether attenuation of changes translate into financial penalties but it seems very likely to increase a hospital s risk We also do yet fully understand what specific changes produce these decreases in the population based discharge rate but the most parsimonious explanation is that the causes are pretty much the causes of reduced readmissions Provide urgent care with support for keeping the patient in the community and you are likely to reduce all admissions not just readmissions Enroll more patients in medical homes and the benefits will not disappear 30 days after hospital discharge Improve nursing home communications with emergency rooms and the benefits will not be limited to patients within 30 days after hospital discharge What we can foresee is that hospitals already wary of readmissions reduction because it directly reduces revenue will become doubly wary if they conclude that reducing discharges may also cause or increase the MRRP penalty If CMS is penalizing hospitals and communities for succeeding at improving care and reducing costs the reaction may threaten a very successful set of initiatives The examples we report are for community based efforts to reduce readmissions Hospital level calculations are generally beyond our capability CMS can however easily determine whether all else being equal penalties are more likely or larger in areas where the population based hospital discharge rate is declining substantially than elsewhere That information is urgently needed What to do The purpose of the MRRP is to reduce the burden of readmissions on Medicare beneficiaries and the Medicare trust funds so the important indicator of progress is the number of readmissions not the percentage of discharged patients that are readmitted Healthcare quality measurement needs to catch up with the National Quality Strategy and add measures of the impact of care on the health of the population that will complement measures of the quality of individual episodes of care such as hospitalizations In the case of readmission measurement for the MRRP this need is substantially more urgent because there is good reason to fear that a hospital that engages with its community and does exactly what the MRRP hopes for is more liable to financial penalties under the current discharge based measure than it would be under a population based measure The first step is to assess the degree of urgency by examining national evidence on actual penalties If unreasonable penalties are at all frequent then the problem is far more urgent This will be complex because Epstein has already shown in cross sectional studies that population based hospitalization rates and readmission rates are positively correlated 2 At the same time it will be important to develop population based measures of readmissions and compare their impact on penalties with the impact of discharge based measures The obstacles are bureaucratic technical and political Bureaucratically the most important obstacle has been a widespread belief that the Patient Protection and Affordable Care Act requires calculating discharge based rates In fact

    Original URL path: http://medicaring.org/tag/mrrp/ (2016-04-30)
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  • Post-acute Savings: For Profits or Reinvestment?  – MediCaring.org
    after hospitalization will be to increase the demands on families We will expect them to provide ever more care to people who would once have still been in the hospital or nursing home Most just discharged elders will have ongoing needs for supplemental services at home Since many will not meet current Medicare requirements for such care they and their families will have to pay even more out of pocket They will spend down to Medicaid more quickly Also the effective arrangements for follow up that many hospital based practitioners have had will be disrupted The orthopedist who could count on the skilled nursing facility or inpatient rehabilitation facility to implement shared protocols will now have patients going home more quickly and to family caregivers who cannot reliably follow instructions or report issues Many very old people will not have homes and families able to take them in or to drop everything to provide care Many of the essential services e g personal care housing food transportation caregiver support and training will have to be paid for privately or by Medicaid If in the end Medicaid pays more and families are more depleted have we really saved money Did we get what we really wanted Investing Shared Savings to Build Medicare 2030 What if we invested much of the projected savings to support frail elders better in their communities Doing so would slow the rate of spending to Medicaid and buttress family caregiving by providing for example stipends respite care and training Very old people could feel more confident and avoid being plagued by fears of burdening families going without food or living in inadequate or overly expensive housing For now we could allow the efficiency contractors to implement the changes broadly enough to create irrevocable change and then build a new system on their success or we could aim to build the new system that generates the efficiencies and reinvests the savings from the start Both strategies would keep public funds working in the public interest at least eventually What s your role in all of this Write to your elected officials or talk with them when they hold a forum Express your concerns as an old person in training and as a citizen We are building the system into which our parents our spouses and we ourselves will age Surely in protecting our own future we can craft a better one for us all Make a comment below and let us know how you see things Want Links to Learn More Building reliable and sustainable comprehensive care for frail elderly people http altarum org our work jama reliable and sustainable comprehensive care for frail elderly people Health Affairs blog by Joanne Lynn on where savings should go http healthaffairs org blog 2014 04 24 only evidence based after hospital care where should the savings go Institute of Medicine IOM report on variation in post acute care http www iom edu media Files Report 20Files 2013 Geographic Variation2 geovariation

    Original URL path: http://medicaring.org/2014/04/30/post-acute-savings/ (2016-04-30)
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  • Dr. Joanne Lynn – MediCaring.org
    or Reinvestment Learning from Reviewing Readmissions Tools You Can Use Care Transitions Activism for Geriatrics and Palliative Care Care Transitions Measurement 101 Tough customers who need care transitions most MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality risk due to care transitions Bel Marra Health April 14 2016 Central Wyoming Caring Transitions Owners Recognized for Pioneer Spirit PR Web press release April

    Original URL path: http://medicaring.org/author/drjoannelynn/ (2016-04-30)
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  • financing – MediCaring.org
    with what we save Where Will the Elders Go And the Money One likely effect of dramatically trimming services available to elders after hospitalization will be to increase the demands on families We will expect them to provide ever more care to people who would once have still been in the hospital or nursing home Most just discharged elders will have ongoing needs for supplemental services at home Since many will not meet current Medicare requirements for such care they and their families will have to pay even more out of pocket They will spend down to Medicaid more quickly Also the effective arrangements for follow up that many hospital based practitioners have had will be disrupted The orthopedist who could count on the skilled nursing facility or inpatient rehabilitation facility to implement shared protocols will now have patients going home more quickly and to family caregivers who cannot reliably follow instructions or report issues Many very old people will not have homes and families able to take them in or to drop everything to provide care Many of the essential services e g personal care housing food transportation caregiver support and training will have to be paid for privately or by Medicaid If in the end Medicaid pays more and families are more depleted have we really saved money Did we get what we really wanted Investing Shared Savings to Build Medicare 2030 What if we invested much of the projected savings to support frail elders better in their communities Doing so would slow the rate of spending to Medicaid and buttress family caregiving by providing for example stipends respite care and training Very old people could feel more confident and avoid being plagued by fears of burdening families going without food or living in inadequate or overly expensive housing For now we could allow the efficiency contractors to implement the changes broadly enough to create irrevocable change and then build a new system on their success or we could aim to build the new system that generates the efficiencies and reinvests the savings from the start Both strategies would keep public funds working in the public interest at least eventually What s your role in all of this Write to your elected officials or talk with them when they hold a forum Express your concerns as an old person in training and as a citizen We are building the system into which our parents our spouses and we ourselves will age Surely in protecting our own future we can craft a better one for us all Make a comment below and let us know how you see things Want Links to Learn More Building reliable and sustainable comprehensive care for frail elderly people http altarum org our work jama reliable and sustainable comprehensive care for frail elderly people Health Affairs blog by Joanne Lynn on where savings should go http healthaffairs org blog 2014 04 24 only evidence based after hospital care where should the savings go Institute

    Original URL path: http://medicaring.org/tag/financing/ (2016-04-30)
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  • post-acute care – MediCaring.org
    with what we save Where Will the Elders Go And the Money One likely effect of dramatically trimming services available to elders after hospitalization will be to increase the demands on families We will expect them to provide ever more care to people who would once have still been in the hospital or nursing home Most just discharged elders will have ongoing needs for supplemental services at home Since many will not meet current Medicare requirements for such care they and their families will have to pay even more out of pocket They will spend down to Medicaid more quickly Also the effective arrangements for follow up that many hospital based practitioners have had will be disrupted The orthopedist who could count on the skilled nursing facility or inpatient rehabilitation facility to implement shared protocols will now have patients going home more quickly and to family caregivers who cannot reliably follow instructions or report issues Many very old people will not have homes and families able to take them in or to drop everything to provide care Many of the essential services e g personal care housing food transportation caregiver support and training will have to be paid for privately or by Medicaid If in the end Medicaid pays more and families are more depleted have we really saved money Did we get what we really wanted Investing Shared Savings to Build Medicare 2030 What if we invested much of the projected savings to support frail elders better in their communities Doing so would slow the rate of spending to Medicaid and buttress family caregiving by providing for example stipends respite care and training Very old people could feel more confident and avoid being plagued by fears of burdening families going without food or living in inadequate or overly expensive housing For now we could allow the efficiency contractors to implement the changes broadly enough to create irrevocable change and then build a new system on their success or we could aim to build the new system that generates the efficiencies and reinvests the savings from the start Both strategies would keep public funds working in the public interest at least eventually What s your role in all of this Write to your elected officials or talk with them when they hold a forum Express your concerns as an old person in training and as a citizen We are building the system into which our parents our spouses and we ourselves will age Surely in protecting our own future we can craft a better one for us all Make a comment below and let us know how you see things Want Links to Learn More Building reliable and sustainable comprehensive care for frail elderly people http altarum org our work jama reliable and sustainable comprehensive care for frail elderly people Health Affairs blog by Joanne Lynn on where savings should go http healthaffairs org blog 2014 04 24 only evidence based after hospital care where should the savings go Institute

    Original URL path: http://medicaring.org/tag/post-acute-care/ (2016-04-30)
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  • shared savings – MediCaring.org
    with what we save Where Will the Elders Go And the Money One likely effect of dramatically trimming services available to elders after hospitalization will be to increase the demands on families We will expect them to provide ever more care to people who would once have still been in the hospital or nursing home Most just discharged elders will have ongoing needs for supplemental services at home Since many will not meet current Medicare requirements for such care they and their families will have to pay even more out of pocket They will spend down to Medicaid more quickly Also the effective arrangements for follow up that many hospital based practitioners have had will be disrupted The orthopedist who could count on the skilled nursing facility or inpatient rehabilitation facility to implement shared protocols will now have patients going home more quickly and to family caregivers who cannot reliably follow instructions or report issues Many very old people will not have homes and families able to take them in or to drop everything to provide care Many of the essential services e g personal care housing food transportation caregiver support and training will have to be paid for privately or by Medicaid If in the end Medicaid pays more and families are more depleted have we really saved money Did we get what we really wanted Investing Shared Savings to Build Medicare 2030 What if we invested much of the projected savings to support frail elders better in their communities Doing so would slow the rate of spending to Medicaid and buttress family caregiving by providing for example stipends respite care and training Very old people could feel more confident and avoid being plagued by fears of burdening families going without food or living in inadequate or overly expensive housing For now we could allow the efficiency contractors to implement the changes broadly enough to create irrevocable change and then build a new system on their success or we could aim to build the new system that generates the efficiencies and reinvests the savings from the start Both strategies would keep public funds working in the public interest at least eventually What s your role in all of this Write to your elected officials or talk with them when they hold a forum Express your concerns as an old person in training and as a citizen We are building the system into which our parents our spouses and we ourselves will age Surely in protecting our own future we can craft a better one for us all Make a comment below and let us know how you see things Want Links to Learn More Building reliable and sustainable comprehensive care for frail elderly people http altarum org our work jama reliable and sustainable comprehensive care for frail elderly people Health Affairs blog by Joanne Lynn on where savings should go http healthaffairs org blog 2014 04 24 only evidence based after hospital care where should the savings go Institute

    Original URL path: http://medicaring.org/tag/shared-savings/ (2016-04-30)
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  • Senate Works to Advance Care Plans: Listen to Senator Mark Warner’s Take – MediCaring.org
    Establishing a reimbursement mechanism under Medicare Part B for patients with advanced illness who meet criteria of frailty and who can benefit from care planning conversations with an interdisciplinary team 2 Launch a pilot study Advanced Illness Care Coordination Serivces to learn more about how to provide the care envisioned in such plans 3 Develop systems that ensure the plans are valid in any and all settings 4 Issue grants to disseminate information and educate the public and stakeholders Warner s brief remarks offer insights gleaned from his years as the son of a woman who had Alzheimer s and his many years in shaping public policy You can watch them here key words Mark Warner Johnny Isakson advance care plans public policy palliative care Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI JAMA Focus on Helping Family Caregivers Resources for Advance Care Planning include Handbook for Mortals MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons

    Original URL path: http://medicaring.org/2014/03/20/senate-works-to-advance-care-plans-listen-to-senator-mark-warners-take/ (2016-04-30)
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  • Johnny Isakson – MediCaring.org
    effort that was derailed a few years ago with the death panel debacle The proposed legislation Warner says includes 4 key elements 1 Establishing a reimbursement mechanism under Medicare Part B for patients with advanced illness who meet criteria of frailty and who can benefit from care planning conversations with an interdisciplinary team 2 Launch a pilot study Advanced Illness Care Coordination Serivces to learn more about how to provide the care envisioned in such plans 3 Develop systems that ensure the plans are valid in any and all settings 4 Issue grants to disseminate information and educate the public and stakeholders Warner s brief remarks offer insights gleaned from his years as the son of a woman who had Alzheimer s and his many years in shaping public policy You can watch them here key words Mark Warner Johnny Isakson advance care plans public policy palliative care MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality risk due to care transitions Bel

    Original URL path: http://medicaring.org/tag/johnny-isakson/ (2016-04-30)
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