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Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents

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08/27/15 - CMS Posts Funding Opportunity Announcement for Phase Two of Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.

The Medicare-Medicaid Coordination Office, in collaboration with the Center for Medicare & 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 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 potentially avoidable inpatient hospitalizations. 

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 individuals 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

For the past three years, CMS has partnered with seven organizations (referred to as "enhanced care & coordination providers" or "ECCPs") to implement evidence-based clinical and educational interventions that reduce avoidable hospitalizations. These seven organizations (see below) each provide on-site services in a group of partner nursing facilities, including direct care and staff training.  

On August 27, 2015, CMS is announcing a new funding opportunity to launch the second phase of this initiative. In this phase currently participating ECCP organizations may apply to test whether a new payment model for nursing facilities and practitioners, together with the current evidence-based clinical and educational interventions, will reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by long-stay nursing facility residents. 

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. Improving the capacity of nursing facilities to treat common medical conditions as effectively as possible on-site in the facilities, as appropriate, has the potential to improve the residents' care experience at lower cost than a hospital admission. The model also includes Medicare payments to practitioners (i.e., physicians, nurse practitioners and physician assistants) at a level similar to the payments they would receive for treating beneficiaries in a hospital. Practitioners would also be eligible to receive new payments for engagement in multidisciplinary care planning activities. Successful ECCP applicants will implement the payment model with both their existing partner facilities, where they currently provide training and clinical interventions, and in a comparable number of newly recruited facilities. The payment model is slated to run from October 2016 to October 2020.  

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 the CMS Innovation Center's website at: 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.