September 26, 2013

Message from Deputy Vice Chancellor Pinson about the Transitions Program

A front-page article in Tuesday’s Tennessean has created misperceptions about Vanderbilt University Medical Center’s efforts to assist patients who no longer need acute hospital services, but may need further care in another setting such as a rehabilitation hospital, nursing facility or at home through the support of home health.

The reality in Middle Tennessee and elsewhere throughout our nation is that tens of millions of patients do not have insurance coverage necessary to make post-acute care possible. For these patients options are typically very limited or non-existent. Keeping a patient in an acute care setting for post-acute care is less than ideal from a quality perspective and wasteful from a financial perspective. Other facilities are better designed, staffed and equipped to deliver post-acute care services.

We are committed to providing value-based care to our community. Value-based care includes getting patients to the appropriate level of care at the right time. Due to the complexities surrounding transitions for patients from the acute care setting, we all want and need new solutions.

In 2012, the Medical Center developed and implemented a patient transition initiative now called the Transitions Program to ensure smoother, more tightly coordinated transitions from the hospital’s acute care setting to each patient’s home or other post-acute care settings.

Medicare, TennCare and commercial insurers all share requirements that patients be treated in the least intensive setting commensurate with the patients’ needs. Patients covered through these forms of insurance are routinely transferred to post-acute settings. When there is no insurance involved and patients and their families don’t have the resources to pay for post-acute care, it makes sense for the Medical Center to fund services for these patients, allowing them to transition into the most appropriate setting for their needs — but only when our patients no longer need to remain in the acute care setting. Our physicians make decisions based on defined clinical criteria for when it is appropriate to discharge their patients.

The Transitions Program is intended to place uninsured patients on the same footing, providing them with the same post-acute services as those who are insured. The program was designed and implemented to provide all patients care at a level commensurate with their needs while also freeing up much-needed capacity for truly acute patients.

We all want and need new solutions in the current cost-constrained and complex health care environment. Because we are a national leader, consumers and insurance payers expect creativity and innovation to address access issues and the costs of health care services. A more seamless coordination of care between hospitals and post-acute providers is an important element in the effort to bend health care’s cost curve. The Transitions Program is one of only many ways the Medical Center coordinates the post-acute care needs of patients who are ready to leave the hospital.

C. Wright Pinson, MBA, M.D.
Deputy Vice Chancellor for Health Affairs
CEO of the Vanderbilt Health System