ICD-10 Implementation in a 5010 Environment

Report
CMS National Conference
on Care Transitions
December 3, 2010
1
Community-based Care
Transitions Program (CCTP)
Juliana R. Tiongson
Social Science Research Analyst
Centers for Medicare and Medicaid
Services
Office of Research, Development and
Information
2
The Community–based Care
Transitions Program
• The CCTP, mandated by section 3026 of the
Affordable Care Act, provides funding to test
models for improving care transitions for high
risk Medicare beneficiaries.
• Increasing rates of avoidable hospital
readmissions will result in negative health
outcomes for Medicare beneficiaries impacting
their levels of safety and quality of care.
• The CCTP seeks to correct these deficiencies by
encouraging communities to come together and
work together to improve quality, reduce cost,
and improve patient experience.
3
Program Goals
• Improve transitions of beneficiaries from
the inpatient hospital setting to other care
settings
• Improve quality of care
• Reduce readmissions for high risk
beneficiaries
• Document measureable savings to the
Medicare program
4
Eligible Applicants
• Are statutorily defined as:
−Acute Care Hospitals with high
readmission rates in partnership with a
community based organization
−Community-based organizations (CBOs)
that provide care transition services
• There must be a partnership between the
acute care hospitals and the CBO
5
Definition of CBO
• Community-based organizations that
provide care transition services across the
continuum of care through arrangements
with subsection (d) hospitals
−Whose governing bodies include
sufficient representation of multiple
health care stakeholders, including
consumers.
6
Key Points
• CBOs will use care transition services to
effectively manage transitions and report process
and outcome measures on their results.
• Applicants will not be compensated for services
already required through the discharge planning
process under the Social Security Act and
stipulated in the CMS Conditions of Participation.
• Applicants will be required to participate in
ongoing learning collaboratives
7
Requirements
– Initiating care transition services no later than 24 hours
prior to discharge
– Providing timely, culturally, and linguistically competent
post-discharge education
– Ensure timely and productive interactions between
patients and providers
– Medication review and management
– Patient centered self-management support
8
Preferences
• Preference must be given to
applications that :
– include participation in a program
administered by the AoA
– provide services to medicallyunderserved populations, small
communities and rural areas
• Physician group practices
Application Guidance
– Applicants are required to complete a
root cause analysis
– The proposals must specify how the root
causes will be addressed
– how they will work with accountable
care organizations and medical homes
– how they will align their care transition
programs
Conclusion
• A program solicitation will be announced shortly
in the Federal Register
• Please visit our program website for daily updates
on program status at
http://www.cms.gov/DemoProjectsEvalRpts/MD/i
temdetail.asp?itemID=CMS1239313
• Please direct questions to
[email protected]

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