Better Care Coordination Will Save Tax Payers Billions

After experiencing discomfort, 75-year-old Stan visited his doctor and was ultimately rushed to the hospital and into surgery to remove a blockage from his large intestine. After a short time, he was transferred to a nearby rehabilitation facility for short-term rehabilitation covered by Medicare. During the first week of his stay, he developed a urinary tract infection and pneumonia and was readmitted to the hospital. Weak and uncomfortable, Stan hung in there with the support of his family and thoughts of his grandchildren to keep him going. His daughter, who is a nurse in another state, knew that the infection and the readmission to the hospital could have been prevented with better care coordination and transitional planning for Stan as he was moved from the hospital to the rehabilitation facility.

Evidence has long shown that poorly coordinated transitions and hospital readmissions are both excessively costly and risky. According to the Centers for Medicare and Medicaid Services (CMS) Website, nearly one in five Medicare patients (approximately 2.6 million seniors) discharged from a hospital are readmitted within 30 days at a cost of over $26 billion to tax payers every year. Researchers with the Robert Wood Johnson Foundation (RWJF) estimated that 75% of chronically ill patients who leave the hospital wouldn’t need a return trip if they had a plan for follow-up care, including support and encouragement to take their medications, follow proper diets, show up for follow-up appointments, and otherwise follow the regimens that doctors have prescribed during their hospitals stays.

Given the risk to patients and the cost to tax payers, there is certainly a need to provide greater support for Medicare patients as they transition from the hospital back home or to a skilled nursing care facility. To support people coming out of the hospital so they don’t wind up right back in, CMS introduced the Community-based Care Transitions Program (CCTP) as part of the Partnership for Patients initiative. CCTP is a nationwide public-private partnership that was mandated by Section 3026 of the Affordable Care Act, in an effort to reduce preventative errors in hospitals by 40% and reduce hospital readmissions by 20%. There are currently 102 participating sites involved in CCTP.

Sites that participate in the CCTP program aim to:

  • improve assessment, planning, medications management, movement between care levels, and coordination of support services such as meals and medical equipment;
  • enhance quality of care;
  • ease transitions of beneficiaries from the inpatient hospital setting to other care settings;
  • reduce readmissions for high-risk beneficiaries;
  • document measureable savings to the Medicare program.

According to CMS, patient and family engagement is also a key part of keeping patients from getting injured or sicker in the hospital, improving transitions across health care settings, and reducing readmissions. Learn more about the importance of patient engagement on the CMS Website.

What if Stan in our example needs long-term care down the road? It is important to understand that Medicare, the public health insurance system for seniors over 65 and disabled adults, does not pay one penny for long-term care. Medicare only pays for medical care delivered by doctors and hospitals, and in certain cases short-term rehabilitation which might take place in a nursing home.  To get the government to help you pay for long-term care, you need Medicaid, but when it comes to Medicaid, it gets very complicated to complete and file the application and, in most cases, it takes an experienced Elder Law firm such as the Farr Law Firm, to help protect your assets first and then file for Medicaid.

Nursing homes in Fairfax, Virginia and the rest of Northern Virginia can cost as much as $198,000 per year, while Fredericksburg, Virginia nursing homes and nursing homes in and the rest of Virginia can cost as much as $105,000 per year. Generally, the earlier someone plans for long-term care needs, the better.  But it is never too late to begin preparing.  Even if a loved one was already in a nursing home receiving long-term care, it would not be too late to do Long-term Care Planning, also called Lifecare Planning and Medicaid Asset Protection Planning.

If you have a loved one who is nearing the need for long-term care or already receiving long-term care or if you have not done Long-Term Care Planning, Estate Planning or Incapacity Planning (or had your Planning documents reviewed in the past several years), please call The Fairfax and Fredericksburg Long-Term Care Planning Law Firm of Evan H. Farr, P.C. at 703-691-1888 to make an appointment for an introductory consultation.

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