Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (NFI)
The Medicare-Medicaid Coordination Office, in collaboration with the Center for Medicare & Medicaid Innovation, is helping to improve the quality of care for people in long-term care (LTC) facilities by reducing potentially avoidable inpatient hospitalizations.
The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is focused on long-stay LTC facility residents who are enrolled in the Medicare and Medicaid programs. The Initiative supports organizations that partner with LTC facilities to implement evidence-based interventions that both improve care and lower costs.
LTC facility residents often experience potentially avoidable hospital transfers. Unnecessary hospitalizations are expensive, disruptive, and disorienting for frail elders and people with disabilities. LTC 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 LTC facility residents are enrolled in both the Medicare and Medicaid programs (Medicare-Medicaid enrollees). CMS research on this population has repeatedly found that a large number of hospital admissions could have been avoided. More information can be found at the links below:
- Cost Drivers for Dually Eligible Beneficiaries: Potentially Avoidable Hospitalizations from Nursing Facility, Skilled Nursing Facility, and Home and Community-Based Services Waiver Programs (August 2010) (PDF)
- Dual Eligible Beneficiaries and Potentially Avoidable Hospitalizations Policy Insight Brief (September 2011) (PDF)
- Medicare-Medicaid Eligible Beneficiaries and Potentially Avoidable Hospitalizations Medicare & Medicaid Research Review (2014) (PDF)
- Data Brief: Sharp reductions in avoidable hospitalizations among long-term care facility residents (2017)
CMS is partnering with several organizations, referred to as "enhanced care & coordination providers" or "ECCPs", to implement evidence-based clinical and educational interventions that reduce avoidable hospitalizations.
While each ECCP's intervention has unique features, all include:
- Employing staff who will maintain a physical presence on site at LTC facilities;
- Allowing for participation by LTC facility residents without any need for residents to change providers or enroll in a health plan; and
- Supplementing (rather than replacing) existing care provided by LTC facility staff.
Phase One: Improving Clinical Care
Between 2012 and 2016, CMS partnered with seven ECCPs, each providing on-site services in a group of partnering nursing facilities. Five of the organizations focused on direct care, and two focused on staff training.
An independent evaluation found "persuasive evidence of the Initiative's effectiveness in reducing hospital inpatient admissions, ED visits, and hospitalization-related Medicare expenditures."
Phase Two: Adding Payment Reform
On August 27, 2015, CMS announced a new funding opportunity to launch the second phase of this Initiative.
The intent of the new payment model is to reduce potentially-avoidable hospitalizations by funding higher-intensity treatment services in nursing facilities for residents who may otherwise be hospitalized upon an acute change in condition.
On March 24, 2016, CMS announced cooperative agreements with the six organizations below to implement Phase Two of the Initiative.
Alabama Quality Assurance Foundation – Alabama
HealthInsight of Nevada – Nevada and Colorado
Indiana University – Indiana
The Curators of the University of Missouri – Missouri
The Greater New York Hospital Foundation, Inc. – New York
University of Pittsburgh Medical Center (UPMC) Community Provider Services - Pennsylvania
Over 250 LTC facilities have been selected to implement this phase of the Initiative.
For more information or questions about this Initiative, email NFI@cms.hhs.gov.