$500M in Readmission Prevention Funds to Bypass Hospitals

In fact, Section 3026 makes hospitals so nervous, applications to the Centers for Medicare & Medicaid Services have barely trickled in and deadlines keep slipping. What's the holdup?

Apparently, part of the problem is a cultural gap that has made hospitals and CBO partnerships tough to forge. One hospital official commented on background that they "can't find a CBO that they can work with."

I interpret that statement as an indication they "can't find a CBO they can trust."

After all, CBOs speak a different language and work with different expectations than the hospital; one works in a rigid high-acuity medical/surgical role and, the other, in a more open-ended, social support one.

But that's the whole point, says a CMS representative.

"This was based on work done by 14 QIOs (who work under Medicare contracts with hospitals) who improved care transitions and reduced readmissions by working within their communities," said CMS spokeswoman Ellen Griffith Cohen.  

"Section 3026 was based on the idea that conducting these efforts at a community level is very important because hospitals are only one piece of the equation," she says. And, CMS is looking for a true "community partnership," she says, leaning more favorably "toward applicants that include downstream providers, as well as hospitals and CBOs." The CBOs "must be broadly representative of community stakeholders, including consumers," Griffith Cohen says.

"It's coaching, following the patient, providing transportation for example, to weave that patchwork together to make sure that once they are out of the hospital they proceed on a path to get them back to where they were before they were hospitalized," she says.

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