Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
In Reply: The short answer to Dr Edes' question
is that the transitional care model does not fit current systems of health
care delivery. This model has not been embraced by fee-for-service or managed
care Medicare. Historically, Medicare has paid little attention to sick, chronically
ill elders. The 1997 Balanced Budget Act has further reduced the limited home
health care services available to these patients.
The legacy of America's medical progress in the last half century is
an increasing number of older adults living longer with multiple health problems.1 Despite changing needs, Medicare continues to use
an acute care model to solve health problems of a chronically ill population.
The body of evidence underscoring the inadequacy of this model continues to
increase. The high rate of preventable hospital readmissions among Medicare
beneficiaries is one example of the failure of the health care system to respond
to changing needs.
Naylor MD. Comprehensive Home Care After Hospitalization of Elderly Patients—Reply. JAMA. 1999;282(12):1129. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922