April 16 marked the first of what the Centers for Medicare & Medicaid Services (CMS) officials plan to be an annual National Care Transitions Awareness Day. The observance, held in Baltimore, Maryland, comprised a range of speakers and exchange of information and ideas.
At the heart of the matter: helping beneficiaries and their families navigate the complicated journey of health care and care transitions, from illness to treatment to maintenance.
“Yes, we want to raise awareness about the importance and value of care transitions for our beneficiaries. But most importantly we want to promote action,” said Dr. Adebola Adeleye, lead of the CMS Care Transitions & Post-Acute Care (CTPAC) Affinity Group. “We want everybody joining us in this effort to raise awareness, to promote action in your communities and to improve care transitions for the beneficiaries that we serve.”
Throughout the day speakers addressed many points of view, with perspectives that included patients, caregivers and other members of the health care community. Recurring themes centered on carrying forward the patient story and not allowing critical data and context to get lost in transitions between doctors, diagnoses, providers or locations.
“A patient once told me that the only common denominator between specialists and primary care hospitals, nursing homes and nursing facilities in the American health care system is the patient,” said Dennis Wagner, CMS director of the Quality Improvement and Innovation Group within CMS’ Center for Clinical Standards and Quality. “And we're trying to change that picture so that the only common denominator is not just the patient, but also caregivers who are connected seamlessly in ensuring that we have the proper transitions of care.”
Jean Moody-Williams, acting administrator for the Consortium for Quality Improvement and Survey & Certification Operations at CMS, shared her mother’s journey from home to the hospital to a rehab facility to home hospice, with more stops in between. Along the way, much of her health story would get lost — “and the story is so important,” Moody-Williams said.
To that end, one effort underway at CMS is a proposed interoperability rule, announced in February. If implemented as planned, the rule would make it easier to access, move and share patient health information, including across platforms by using more open standards in data-sharing technology.
“The rule proposes changes to the health care delivery system that can increase the seamless flow of health information, reduce burden on patients and providers and foster innovation,” Seema Verma, CMS administrator, said via video address. “By ensuring patients have access to their information, no matter what type of provider or which type of insurance, we can reduce burden, eliminate redundant procedures and testing and give back valuable clinician time to focus on improving care coordination and ultimately health outcomes.”
Patient empowerment was another point of emphasis throughout the event, starting with opening keynote speaker Richard Knight, president of the American Association of Kidney Patients’ Board of Directors and kidney transplant recipient. Knight’s experience navigating chronic kidney disease served as a prime example of what NCTA Day organizers hope to shed light on. Knight shared his story, from discovering the illness after applying for life insurance to obligatory self-education to hemodialysis to successful transplant.
After that, he dedicated himself to raising the kind of awareness he didn’t have when he was diagnosed.
“Patients are not victims,” Knight said. “This isn’t what we want, but it’s what we have to live with. The question is, how can we make a difference?”