Reference no: EM133815767

Question 

Transfer of patient from one care setting that is a hospital to another may be a rehabilitation center, or home-based care is termed as the transition of care. The Center does it for Medicare and Medicaid Services, popularly known as CMS. Coordinating care in the health care system is crucial in managing, evaluating, and implementing a patient's treatment plan. Therefore, there should be a smooth and successful transition to ensure patients health condition does not deteriorate. If there is a less effective transition, it may result in the readmission of patients to the hospital. In most cases, readmission may occur due to poor communication and poor coordination of services. Additionally, other factors may lead to patient readmissions, such as incomplete treatment, inadequate access to care, and incomplete discharge planning.