Hospitals in New CMS Pilot Starting to See Readmissions Fall

Hospitals participating in a CMS pilot project to lower readmission rates are beginning to see the rates fall, according to a report by the New York Times.


CMS' chief medical officer said hospitals in CMS' Care Transitions project in 14 communities across the country are beginning to see readmissions "inch down," about seven months after the project started, theTimes reports.

The key is the use of "health coaches," who guide high-risk patients through discharge and monitor their progress in the first month post-discharge.

In the Care Transitions project in Baton Rouge, La., only seven of 145 patients coached so far have had to be rehospitalized.

Top risks for rehospitalization are:
  • not taking medications,
  • not seeing a physician for a follow-up appointment within a week of discharge, and
  • not detecting early signs of trouble and taking action.


The project, which began in April, is coordinated by CMS-selected quality improvement organizations (QIOs) in the following communities:

  • Providence, R.I.
  • Upper Capitol Region, N.Y.
  • Western Pennsylvania
  • Southwestern New Jersey 
  • Metro Atlanta East, Ga. 
  • Miami
  • Tuscaloosa, Ala.
  • Evansville, Ind.
  • Greater Lansing Area, Mich.
  • Omaha, Neb.
  • Baton Rouge, La.
  • Northwest Denver, Colo. 
  • Harlingen, Texas
  • Whatcom County, Wash.

Read the New York Times' report on hospital readmissions.


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