CMS Medicaid Nursing 
Stroke Journal
JANUARY 30, 2025
This initiative aimed to enhance the post-discharge process to improve care quality and reduce missed follow-ups.Methods:We implemented a streamlined follow-up process for stroke patients discharged home, aligning with the Centers for Medicaid and Medicare (CMS) definition of the Transitional Care Management (TCM).
Stroke Journal
JANUARY 30, 2025
This initiative, led by Advanced Practice Providers (APPs), aimed to refine the post-discharge process to enhance care quality and reduce missed follow-ups.Methods:We introduced a streamlined follow-up process for stroke patients discharged home, adhering to the Centers for Medicaid and Medicare (CMS) Transitional Care Management (TCM) model.
DAIC
JUNE 4, 2024
I know the nurse explained my medications to me at the hospital. This math deficit was not recognized until I got home. I lived alone and I had to take care of myself, and I was unable to cope. The simple act of maintaining post-care medications was extremely difficult for me. This missing puzzle piece matters now more than ever.
Stroke: Vascular and Interventional Neurology
NOVEMBER 9, 2023
Factors considered in analysis include patient age, sex, geographic region, Medicaid dual eligibility, disability status prior to age 65, comorbidities, admission length of stay, discharge disposition, and hospital characteristics. Discharge disposition of subacute nursing facility (SNF) represents 36.1% female and 83.1%
The Beat Blog
AUGUST 12, 2022
These days, it’s significant that The Center for Medicare and Medicaid Innovation has clearly expressed that they want every Medicare beneficiary in an accountable care plan by 2030. And their newest program, called ACO Reach, has attracted hundreds of applicants, as CMS seeks to ensure historically underserved patients are fully included.
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