Relias

MAY 16, 2025

Patients unplanned returns to the hospital after discharge drive up costs, disrupt recovery, and reflect gaps in care. Under HRRP, hospitals received financial penalties if their readmission rates exceeded the national average a move that drove greater attention to discharge protocols and transitional care.

Discharges 75

Discharges Follow-Up Acute Care Hospital 75

Guideway Care

DECEMBER 23, 2024

Key Takeaways Transitional Care Management (TCM) improves care coordination and significantly reduces hospital readmissions through a structured approach that encompasses patient follow-up and communication. Initiatives such as Project RED and BOOST augment care transitions by conducting follow-up calls with patients.

Discharges 52

Discharges Follow-Up Patient Satisfaction Transfers 52

Relias

OCTOBER 28, 2022

Comprehensive education for home health staff is vital to boost performance under HHVBP, observed Relias Director of Post-Acute Care Solutions Trish Richardson, MSN, BSBA, RN, NE-BC, CMSRN. Hospices should also be concerned about care coordination. As part of discharge planning. Increased scrutiny in hospices.

Hospice 52

Hospice Interdisciplinary Team Follow-Up Documentation 52

Relias

FEBRUARY 26, 2024

By incorporating care coordination practices such as risk assessment, care planning, care transitions, patient education, patient navigation, telehealth, and home visits, care coordination teams can bring in resources to help patients navigate health concerns that span physical, behavioral, and social risk factors and needs.

Care Plan 52

Care Plan Patient Satisfaction Acute Care Collaboration 52

Relias

OCTOBER 10, 2023

They monitor patients’ conditions, administer medication, and convey self-care and discharge information. Because nurses are directly involved with patients on a day-to-day — and often hourly — basis, improving their ability to provide high-quality care is critical to a successful patient safety strategy.

Patient Safety 52

Patient Safety Discharges Communication Medication 52

The HIPAA Journal

DECEMBER 14, 2022

The Centers for Medicare and Medicaid Services (CMS) also published an interoperability rule in March 2020 that applies to Medicare- and Medicaid-participating short-term acute care hospitals, long-term care hospitals, rehabilitation hospitals, psychiatric hospitals, children’s hospitals, cancer hospitals, and critical access hospitals (CAHs).

HIPAA 128

HIPAA Business Associate Appointments Transfers 128