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Integrating Care

As hospitals shorten lengths of stay and as care becomes more fragmented, the process by which patients move from hospitals to other care settings is increasingly problematic. Medicare patients report greater dissatisfaction related to discharges than to any other aspect of care that CMS measures.

In general, rehospitalization rates and health care utilization vary substantially across geographic locations, suggesting opportunities for improvement in areas with higher observed rates. The Medicare Payment Advisory Commission estimates that up to 76% of readmissions within 30 days of discharge may be preventable.

The problem of readmissions involves multiple providers across settings. To understand this complex problem, focus needs to be directed not only at what is going on within hospital walls, but also what is going on after the patient re-enters the community.

VIMI works to promote seamless transitions from the hospital to home, skilled nursing care facilities, hospice  or home health care. Our goal is to not only reduce hospital readmissions within 30 days of discharge but also to create a model for improving care transitions.


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