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).

CMS 40

CMS Stroke Strokes Reimbursement 40

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.

CMS 40

CMS Stroke Strokes Reimbursement 40

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 115

Stroke Strokes Innovation Research 115

Stroke Journal

FEBRUARY 1, 2024

Methods:Data were retrieved from a CMS Qualified Entity housing healthcare utilization data for ≥80% of the Texas state population (100% of Medicare Fee-for-Service). Episodes of care within 1 year of discharge were collated and categorized “Discharged”, “Inpatient Rehab”, “Skilled Nursing”, “Hospice”, “Readmission”, or “Death”.

Medicare 40

Medicare Hemorrhage Inpatient Nursing 40

Stroke Journal

JANUARY 30, 2025

Clinical data extracted from an EMR-driven registry were linked to PAC utilization information retrieved from a CMS Qualified Entity with 80% data for the Texas state population (including 100% of Medicare Fee-for-Service). All claims within 1 year of hospitalization were collated and grouped into corresponding care pathways.

Stroke 40

Stroke Strokes Medicare CMS 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Discharge disposition of subacute nursing facility (SNF) represents 36.1% Fewer females and white individuals had a 90‐day readmission (53.5% female and 83.1% white in 90‐day population compared to 54.9% in study population). of the readmission population compared to 27.8% of the study population and 40.2% of the readmission cohort.

Risk Factors 40

Risk Factors Stroke Strokes Medicare 40

The Beat Blog

AUGUST 12, 2022

And their newest program, called ACO Reach, has attracted hundreds of applicants, as CMS seeks to ensure historically underserved patients are fully included. Broad use of telehealth is very much allowed, as is the waiving of a requirement for a three-day inpatient hospital stay before an admission to a skilled nursing facility.

Medicare 52

Medicare Nursing Health Disparities Cardiovascular Disease 52