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Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents

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07/01/15 - The Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents: Summary of Evaluation as of December 2014 report posted.

The Medicare-Medicaid Coordination Office, in collaboration with the Center for Medicare and Medicaid Innovation, established an initiative to help  improve the quality of care for people in nursing facilities by reducing preventable inpatient hospitalizations.  

CMS is supporting organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs. The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, with the goal of reducing avoidable inpatient hospitalizations. This initiative supports the Partnership for Patients' goal of reducing hospital readmission rates by 20% by the end of 2013.

Background

Nursing facility residents often experience potentially avoidable inpatient hospitalizations. These hospitalizations are expensive, disruptive, and disorienting for frail elders and people with disabilities. Nursing facility residents are especially vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and hospital-acquired infections.

Many nursing facility residents are enrolled in both the Medicare and Medicaid programs (Medicare-Medicaid enrollees). CMS research on Medicare-Medicaid enrollees in nursing facilities found that approximately 45% of hospital admissions among those receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided, accounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005.

Initiative Details

Through this initiative, CMS will partner with eligible, independent, non-nursing facility organizations (referred to as "enhanced care & coordination providers" or "ECCPs") to implement evidence-based interventions that reduce avoidable hospitalizations. Eligible organizations can include physician practices, care management organizations, and other entities. Both for-profit and not-for-profit organizations are eligible to apply.

The ECCPs will collaborate with States and nursing facilities, with each ECCP implementing its intervention in at least 15 partnering nursing facilities.

Applicants will propose an intervention that meets the objectives of the initiative, which those selected will then implement. Interventions will be evaluated for their effectiveness in improving health outcomes and providing residents with a better care experience.

Participating Sites

From a pool of applicants, 7 ECCP organizations were selected for this Initiative:

Alabama Quality Assurance Foundation – Alabama Read More

Alegent Health – Nebraska Read More

HealthInsight of Nevada – Nevada Read More

Indiana University – Indiana Read More

The Curators of the University of Missouri – Missouri Read More

The Greater New York Hospital Foundation, Inc. – New York City Read More

UPMC Community Provider Services - Pennsylvania Read More

General Information

More information is available by visiting this link: http://innovation.cms.gov/initiatives/rahnfr/.  Additional questions can be submitted to NFI@cms.hhs.gov.

Reports

CMS is releasing a report entitled, "Evaluation of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents: Summary of Evaluation as of December 2014". This summary report presents results of the quantitative and qualitative analysis of data from the first Initiative year, 2013. 

The report includes promising initial results through 2013, though it is too early to draw any firm conclusions because the ECCPs were phasing in their interventions during this period. The report found that five of the seven ECCPs showed some degree of reduction in hospitalization levels. For three of the ECCPs, the effect estimated could be considered statistically significant but given the transitional status of the intervention in 2013, the reduction cannot be definitely attributed to the Initiative. For hospitalizations determined to be "potentially avoidable" six of the seven ECCPs showed some reductions. For two of the ECCP groups, the effect estimated could be considered statistically significant but whether these reductions were caused by the Initiative is also unclear given the transitional status of the intervention. Looking at quality of care outcomes as measured by the Minimum Data Set (MDS) the report found that results were mixed and inconclusive.