NEW OPPORTUNITY FOR BETTER CARE FOR NURSING FACILITY RESIDENTS THROUGH ENHANCED COORDINATION EFFORTS
CMS Announces New Initiative to Improve Care for Medicare-Medicaid Enrollees and Reduce Costly and Avoidable Hospitalizations
The Centers for Medicare & Medicaid Services (CMS) today announced the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, a new effort designed to improve care for people living in nursing facilities who are enrolled in Medicare and Medicaid. The initiative aims to reduce costly and avoidable hospitalizations among nursing facility residents by funding organizations that would partner with nursing facilities to provide enhanced on-site services and supports to nursing facility residents. CMS commits up to $128 million to support a diverse portfolio of these evidence-based interventions.
The initiative will be run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve the quality and costs of care in the Medicare and Medicaid programs.
“Being readmitted to a hospital is very difficult for low-income seniors, people with disabilities and their families,” said Acting Administrator Marilyn Tavenner. “Through this initiative, we will work with nursing facilities and hospitals to provide better, person-centered care. By catching and resolving issues early, we can help people avoid costly and stressful hospitalizations."
Through this initiative, CMS will partner with independent organizations to improve care for long-stay nursing facility residents. These organizations will collaborate with nursing facilities and States to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays. Eligible organizations can include physician practices, care management organizations, and other public and not-for-profit entities.
Each organization will propose its own evidence-based intervention and improvement strategy. All participants will have staff on-site at nursing facilities to provide preventive services and improve coordination and communication among providers, helping to provide the resident with a more seamless transition between care settings.
Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare. Many are enrolled in both programs. These Medicare-Medicaid enrollees are among the most vulnerable individuals served by the programs and generally have the most complex health care needs. Research on these 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. This new initiative works to prevent potentially avoidable hospitalizations by providing better, more cost-effective care in nursing facilities.
CMS issued a Request for Applications today and organizations interested in participating in this initiative must submit an application by June 14, 2012. More information about this initiative, including the Request for Applications, is available at: http://innovation.cms.gov/initiatives/rahnfr, or by searching for CFDA 93.621 at: www.grants.gov.