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Care Coordination Tough to Define, Measure

Alexandra Wilson Pecci, for HealthLeaders Media, March 4, 2014

Dailey: ANA has a National Database of Nursing Quality Indicators that over 2,000 hospitals participate in the United States, so it's evaluating the quality of hospital care. But we're very excited that we will be adding ambulatory care.

HLM: Let's move onto reimbursement. How will reimbursement make care coordination better and more common?

Dailey: Reimbursement for care coordination is occurring in a few ways. Reimbursement for reporting on quality of care, and transparent quality reporting, such as Hospital Compare, is pay-for reporting. [There are also] pay-for-quality care programs. So for instance, consumers, purchasers, payers, and other providers, nurses, can look on Hospital Compare and see what the readmission rates are; that's an outcome related to the quality of transitional care and care coordination from hospital to home.

And then there is a pay-for-quality program, the Readmission Reduction Program, which is one of the multiple programs by the Centers for Medicare & Medicaid Services that rewards hospitals with better outcomes of care.

And finally there are care coordination codes that are in discussion by CMS that will… allow for increased reimbursement for eligible providers. By eligible providers we mean advanced practice nurses such as nurse practitioners, nurse midwives, [and] physician assistants, and physicians.

Lamb: The new payment strategies that are under discussion right now, such as capitated payment [and] bundling, all provide new incentives for looking at integration of care. And care coordination at its foundation is all about integration. It's about effective connections between settings; it's passing the baton well.

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