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September 22/29, 1999

Comprehensive Home Care After Hospitalization of Elderly Patients—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(12):1129. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922

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.