by Joanne Lynn
“The Centers for Medicare and Medicaid Services (CMS) has quietly put out two evaluations of the readmissions work– and both documents are remarkable for their failure to evaluate the programs fairly or to provide insights as to what works in what circumstances.
“The Community-Based Care Transitions Program (CCTP) pays community-based organizations (often Area Agencies on Aging) to work with hospitals to improve transitions from hospital to home. This first evaluation, covering the 48 programs that started before 2012 [http://innovation.cms.gov/Files/reports/CCTP-AnnualRpt1.pdf], found just four of them to have made statistically significant gains in reducing the ratio of readmissions to discharges from the participating hospitals.
“The readmissions/discharges metric that CMS and its evaluators use for categorizing success or failure is seriously flawed. CMS has known this for a long time: In 2009, that metric had to be changed during the Quality Improvement Organization (QIO) work in 14 communities because the numerator and denominator were declining together [http://jama.jamanetwork.com/article.aspx?articleid=1558278&resultClick=3].