Official NTOCC Comments

Review the official comments, letters and responses from the National Transitions of Care Coalition (NTOCC).

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Posted on 4/30/2017 by NTOCC ®

An overview of The Negative IMPACTS the Predicted Nursing Shortage could have on Transitions of Care

                   IMPACT NEWSLETTER                     
                May 2017                   

An overview of The Negative IMPACTS the Predicted Nursing Shortage could have on Transitions of Care

Each State’s Predicted Nursing Demand

Nurses play a critical role across the spectrum of health care — and particularly during transitions of care (TOC) when patients are transferred to long-term care facilities. Research from the Agency for Healthcare Research and Quality(AHRQ) has demonstrated that older patients — or those with complex conditions — are particularly vulnerable if TOCs are not managed effectively. As the AHRQ notes, the result can be “adverse events, poorer outcomes, and higher overall costs.” The pivotal role of nurses during such transitions is evidenced by the fact that the American Nurses Association (ANA) identified TOC as a critical component of its 2016 Culture of Safety campaign, and the fact that the nurse-led Transitional Care Model (TCM) has been so effective. 

A Nursing Shortage Ahead

In this context, the predicted nursing shortage poses significant concern regarding TOC — since reduced staffing levels and nurse availability may negatively impact patient outcomes. To better visualize how various regions will be impacted, Nursing@Georgetown, an online FNP program, examined data from a 2014 Health Resources and Services Administration (HRSA) report, “The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025.” The infographic (below) illustrates which states will be most severely impacted by the nursing shortage in the years ahead. Sixteen states are predicted to have a shortage of RNs by 2025 — with Arizona having the most demand. Since a variety of factors are at play, there are many regions that are expected to have a surplus of nurses. 

The Impact on Family Caregivers

In addition to the impact on patient care during TOC, the nursing shortage can also have a direct effect on family caregivers — who may bear an additional burden for ensuring that the details of a loved one’s needs are addressed appropriately. Additionally, though family-centered care is a hallmark of the nursing profession, if nurses feel stressed and overworked about inadequate staffing levels in any setting, relationships with family caregivers suffer. As Katherine Morton Robinson notes in The State of Family Caregiving: A Nursing Perspective, “In order to provide family-centered care, both staffing patterns and staffing supply need to be remedied.”

The Influence of Primary Care

Since there is also a predicted physician shortage in the years ahead — especially in primary care — the combined effect could also have a negative impact on TOC.  However, since advance practice registered nurses (APRNs) can help to bridge this gap, they play an important role in addressing such needs. In fact, in the has proven so effective, APRNs provide oversight and ensure continuity of care for both patients and their families: “The TCM has been tested using master’s prepared APRNs who assume primary responsibility for care management of the older adult throughout episodes of acute illness. These APRNs provide patient-centered, comprehensive, holistic care that is culturally sensitive to the individualized needs of patients and their family caregivers.”

Understanding the dynamics of the predicted nursing shortage ahead can help those involved in TOC to assess available resources and plan accordingly to ensure the highest standards in continuity of care for both patients and their caregivers in the years ahead. 


NTOCC Policy & Advocacy Updates

2017 is shaping up to be an interesting year in healthcare.  There is conflict inside the GOP regarding the appropriate means by which to amend or replace the ACA, and within the Democratic members to defend and hold tight to saving the ACA.


Starting early in February the current political climate in DC and on the hill was focused on Healthcare that  quickly shifted away to foreign policy.  However, Congress and President Trump have returned to talking about the American Healthcare Act (AHA).  The AHA is the proposed bill to amend or replace the Patient Protection and Affordable Care Act (PPACA).  The AHA was originally proposed back in March, but was pulled from the House floor just as the vote was set to be called due to lack of votes for passage.  


By no means have we heard the last about the Patient Protection and Affordable Care Act (ACA) being replaced or repealed. It looks like something will take shape over the next few weeks. With the recently proposed MacArthur amendment failing to pass, the administration and House Republicans are closer now than they were a few weeks ago to getting a bill passed with with the necessary Republican House support.

The MacArthur amendment would have allowed states to seek waivers for several of the key Obamacare insurance reforms regarding pre-existing conditions, the benefits insurers must cover in their policies and the ban on allowing carriers to charge higher premiums based on a person's health history.

The Trump administration says it will remain focused on healthcare and get that resolved before they take on tax reforms, as the two go hand in hand. The GOP needs an additional 22 votes to pass the AHA so their focus is on swaying moderates who are not supportive of the initial version of the bill.

Friday the House voted to fund the government through May 5, which gives lawmakers additional time to negotiate a longer-term funding package. Lawmakers and the President did not hold the funding hostage in exchange for proposed funding for the border wall or repealing or replacing the ACA.

In February 
The U.S. Senate confirmed Tom Price as Health and Human Services secretary. Price, an Orthopedic Surgeon   and vocal opponent of the ACA, was confirmed in a 52-47 vote along party lines after a debate that lasted until about 2 a.m. Price is expected work with Congress on Obamacare’s repeal and replacement. 

The  HR 3381 Childhood Cancer STAR Act was introduced in the House of Representatives by Rep. Michael McCaul (TX-10) , it is currently waiting on review from the Subcommittee on Health.

  • So far the bill has the support of 57 Republicans / 80 Democrats. The Childhood Cancer Star Act is currently in the subcommittee on Health.
  • Of Particular interest to NTOCC is TITLE II—MAXIMIZING DELIVERY: CARE, QUALITY OF LIFE, SURVIVORSHIP, AND CAREGIVER SUPPORT Subtitle A—Childhood Cancer Survivors’ Quality of Life Act. Section ‘‘(G) development of initiatives that promote the coordination and effective transition of care between cancer care providers, primary care physicians, and mental health professionals.
  • ‘‘SEC. 399N–2. WORKFORCE DEVELOPMENT COLLABORATIVE ON MEDICAL AND PSYCHOSOCIAL CARE FOR CHILDHOOD CANCER SURVIVORS.  ‘‘(a) IN GENERAL.—The Secretary shall, not later than 1 year after the date of enactment of the Childhood Cancer Survivorship, Treatment, Access, and Research Act of 2017, convene a Workforce Development Collaborative on Medical and Psychosocial Care for Pediatric Cancer Survivors (referred to in this section as the ‘Collaborative’).  
  • The Collaborative shall be a cross-specialty, multidisciplinary group composed of educators, consumer and family advocates, and providers of psychosocial and 24 biomedical health services......READ MORE

In March

The Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (OMH)  and the Health Resources and Services Administration (HRSA) introduced Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management

  • This is an educational initiative to raise awareness of the benefits of chronic care management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to provide health care professionals with support to implement CCM programs.
  • Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease. The two agencies have developed new resources to help educate patients and provide information for healthcare professionals. You can read more here.

In April 
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare payment and policies when patients are admitted into hospitals.

  • Fiscal Year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective Payment System Proposed Rule, and Request for Information CMS-1677-P. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care. CMS is releasing a Request for Information (RFI) to solicit ideas for regulatory, policy, practice and procedural changes to better achieve transparency, flexibility, program simplification and innovation. This will inform the discussion on future regulatory action related to inpatient and long-term hospitals. Read more about the proposed rule here.
  • CMS will accept comments on the proposed rule and the RFI until June 13, 2017. The proposed rule and the RFI (CMS-1677-P) can be downloaded from the Federal Register at:
HHS announced on April 19th that it will administer grants totaling $485 million to all 50 states to combat opioid addiction. Secretary Price said through a letter to governors: “Through a sustained focus on people, patients, and partnerships, I am confident that together we can turn the tide on this public health crisis."
  • The funding, which is the first of two rounds provided for in the 21st Century Cures Act, will be provided through the State Targeted Response to the Opioid Crisis Grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). You can read the full announcement including each state's allotment here.   
NTOCC continues to encourage individuals to reach out to their elected officials to advocate for improved care transitions in Medicare and Medicaid. 

Upcoming Events you might be interested in............

May 4, 2017--Join the Conversation about Fostering Innovation in Electronic Data Exchange for eMeasurement and Quality Improvement. 
On Thursday, May 4, from 9:00 a.m. to 1:00 p.m. ET, the Office of the National Coordinator for Health Information Technology (ONC), supported by Discern Health, will host a roundtable discussion on opportunities to foster innovation in electronic data exchange for eMeasurement and quality improvement. National thought leaders will share their experiences and insights about innovative approaches. The public is invited to participate and comment.

The meeting will offer a summary of research on the current state and future opportunities to promote better health and care, improved communication and transparency, rapid translation of knowledge for all stakeholders, and reduction in the burden of data collection and reporting for providers. The discussion will focus on various approaches to innovation, including evolving ideas of how registries, data aggregators, and technology solutions interact with systems at the point of care; how organizations are approaching data standardization and quality improvement; and key attributes of evolving eMeasurement and quality improvement models. You can register for the webinar here to participate. 

May 11, 2017 --The CMS Center for Medicare & Medicaid Innovation (CMMI) will host a Public forum for stakeholder feedback. CMMI has been working on developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care. Among those specialty models is the Oncology Care Model, which aims to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare. You can register here for this event.

June 6, 2017--  NTOCC All Member Webinar; Please join us for an update regarding the important changes within NTOCC. All NTOCC Members and Subscribers are encouraged to join this call/webinar.  Feel free to also share this call information with others in the ToC Community who might not know about NTOCC's Tool & Resources.

TIME: 12pm CDT/1pm EDT

Webinar Meeting Link:

Dial-in Number*: (515) 739-1513

Access Code: 986228 

Online Meeting ID:  ntocc

*For help accessing the webinar or if you are one of our International callers and need a country please send an email to for a special number and country code.

                                                                                                                     READ MORE ON OUR WEBSITE                                                                               



Dear NTOCC Community,
I would like to take this portion of the IMPACT to update you on some important changes within the NTOCC Leadership.  I am pleased to announce the 2017 NTOCC Governing Board:

  • James Lett II, M.D., CMD-R, President,

  • Norris Turner, Secretary/ Treasurer, and our Directors

  • Ed Davidson, PharmD, MPH, Director

  • Robyn Golden, LCSW, Director



 The Board has established 4 strategic initiatives for 2017:

  • Increase sponsorship opportunities with new partners

  • Expand the development of additional Transition of Care Pathways

  • Focus on policy issues related to Acute Care/Hospital Readmissions, Post-Acute, Long-term Care, and Mental Health where poor transitions of care increase risk for providers, patients and family caregiver

  • Grow our communication efforts through webinars, all member calls, IMPACT Newsletters, and policy ALERTS with the NTOCC community including social media interactions

NTOCC will continue to focus on what is needed across public policy, tools and resources to improving transitions of care.  As we move into summer NTOCC will focus its policy efforts on ensuring that new legislation or regulations are working to support and improve care coordination and especially the exchange points for transitions.  

Ensuring that hospital transitions whether to home or to post-acute are supported through strong clinical and non-clinical assessments of medication management, patient engagement, timely transfer of information, follow up care, and appropriate transition plans shared with the patient and family caregiver.  To support that effort NTOCC will build education and awareness about the Seven Essential Intervention Categories in the Care Transition Bundle which can be found at listed within the educational Compendium.  

We know that when applying the interventions of the Care Transitions Bundle collaborative care teams improve not only communication with each other and their patients and family caregivers but improve patient safety with addressing  clinical and non-clinical outcomes.  

In 2016, two new transitions of care (TOC) pathways were released in pulmonary diseases, building upon NTOCC’s Seven Essentials care transition interventions. Safer Transitions, Fewer Re-hospitalizations with PAH and Better Transitions of Care to Bridge Gaps, Reduce Hospitalizations and Readmissions in IPF cover essential interventions and pathways designed to ensure effective and safe TOC for patients with pulmonary arterial hypertension (PAH) and idiopathic pulmonary fibrosis (IPF) across healthcare settings.

Each guide highlights practical strategies and tools for coordinating care with the interdisciplinary team tailored to the unique needs of patients with PAH and IPF. Both guides are accredited for ACCME, ANCC, ACPE, and CCM, and can be downloaded at: and

Development of these new pathways was also highlighted in a 2017 article in Professional Case Management, entitled “Integrated Transitions of Care for Patients with Rare Pulmonary Diseases” (Moreo K, et al. Prof Case Manag. 2017;22(2):54-63).

This year, NTOCC, CMSA, and PRIME are partnering again to develop a new pathway to improve TOC for patients with heart failure, who also experience care across multiple settings throughout the course of disease and high rates of preventable hospitalizations. Select health systems who adopt the pathway into practice will have the opportunity to capture real-world data on improvements in medication reconciliation, workflow processes, care coordination, and other TOC processes using NTOCC’s Measurement Platform.

If your health system is interested in learning more about this unique opportunity, please contact NTOCC at 501-240-4677 or PRIME at 954-718-6055.

I hope you will join us on May 16th at 12pm CDT for the NTOCC All Member Webinar.  We have provided that information for you at the end of the Policy & Advocacy Update above.  


Cheri Signature.jpg                                                                                                                                                                                                                                              
Cheri Lattimer

Executive Director


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