Press Releases

FOR IMMEDIATE RELEASE: Friday, August 17, 2012

Contact: Angela L. Yu
Media Relations Manager
(518) 271-5045


TROY, NY - August 17, 2012 - The Eddy Visiting Nurse Association (Eddy VNA), in partnership with five area hospitals and four area counties' Office for the Aging, has been selected by the Centers for Medicare & Medicaid Services (CMS) to implement a Community-based Care Transitions Program (CCTP) in the Capital Region.

A leading not-for-profit provider of home care services, Eddy VNA will serve as the community-based organization (CBO) for the program partnering with three community hospitals -- Albany Memorial Hospital, Samaritan Hospital, and St. Mary's Hospital in Troy; St. Peter's Hospital, a tertiary hospital in Albany; and Columbia Memorial Hospital, a rural hospital in Hudson. The Columbia County Rural Healthcare Consortium, Greene County Long Term Care Council, and the Office for the Aging in Albany, Rensselaer, Columbia and Greene counties also will collaborate.

The Eddy VNA initiative will be based on Dr. Eric Coleman's 30-day Care Transitions Program? which aims to improve care transitions and avoid unnecessary readmissions by supporting patients while they are still in the hospital, and continuing that support for 30 days after discharge. The program will receive federal funding for two years. If proven successful, Eddy VNA will be able to apply annually to renew funding for an additional three years.

"Our mission is to help patients and caregivers manage the care transition by providing increased education and arming them with the knowledge and tools to self-manage their illnesses," stated Michelle Mazzacco, vice president and director of Eddy VNA. "We will teach them what signs and symptoms to look for and when they should immediately contact their physician; and we will reconcile their medications and help them set up a personal health record that can be shared with all their physicians."

Nationally, one in every five Medicare patients discharged from hospitals is readmitted within 30 days, while one in three is readmitted within 90 days. Based on Medicare readmission data, Eddy VNA will target interventions for "high-risk" patients, or those with multiple chronic illnesses such as heart failure, COPD (Chronic Obstructive Pulmonary Disease), diabetes, pneumonia, and AMI (Acute Myocardial Infarction).
"We believe this program will not only help reduce avoidable readmissions, but effect measurable savings to the Medicare system and improve the quality of care and overall patient experience," Mazzacco concluded.

Eddy VNA successfully piloted its own Care Transitions Coach Program with sister facilities, Albany Memorial and Samaritan hospitals, in 2010. The new federal grant will enable the home care provider to expand its efforts to more patients across a wider geographical area. Collectively, the five partnering hospitals admitted more than 16,000 Medicare patients during 2010.

The Centers for Medicare & Medicaid Services is committing $500 million in total funding for the Community-based Care Transitions Program beginning 2011 through 2015. Created by a section of the Affordable Care Act, the CCTP is part of Partnership for Patients, a national safety initiative funded by the Administration to stop preventable injuries and complications, and improve care transitions. Partnership for Patients aims to reduce all hospital readmissions by 20 percent by the end of 2013.
According to CMS, hospitalizations in the U.S. account for approximately 33 percent of total Medicare expenditures. The Medicare Payment Advisory Commission estimates Medicare costs of approximately $15 billion due to readmissions, $12 billion of which are for cases considered preventable. For more information about the Community Based Care Transitions Program, visit


St. Peter's Health Partners was created on October 1, 2011 by the merger of Northeast Health, St. Peter's Health Care Services and Seton Health. The merger created the region's largest and most comprehensive not-for-profit network of high-quality, advanced medical care, primary care, rehabilitation and senior services. These state-of-the-art services and programs are provided through Albany Memorial Hospital and St. Peter's Hospital in Albany; Samaritan Hospital and St. Mary's Hospital in Troy; Sunnyview Rehabilitation Hospital in Schenectady; as well as The Eddy system of continuing care and The Community Hospice. The new organization has more than 11,700 employees at more than 125 locations in seven counties of northeastern New York. St. Peter's Health Partners is the region's largest private employer and has an annual budget of nearly $1.1 billion. For more information, please visit

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