CMS Chooses Seven Nursing Facilities to Reduce Hospitalizations

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).  The Centers for Medicare and Medicaid Services (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. 

To address these concerns, CMS recently announced 7 healthcare entities that will take part in a new initiative, known as the “Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.”  This new effort aims to improve the quality of care for people residing in nursing facilities. 

First announced back in March 2012, the initiative will allow CMS to partner with the seven organizations to implement strategies to reduce avoidable hospitalizations for Medicare-Medicaid enrollees who are long-stay residents of nursing facilities.  The Initiative directly supports CMS’ ongoing work to reduce avoidable hospitalizations for Medicare-Medicaid enrollees.  The organizations include: 

• 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 

The initiative will allow organizations to implement evidence-based interventions that reduce avoidable hospitalizations.  The enhanced care & coordination providers will collaborate with States and nursing facilities, with each enhanced care & coordination provider implementing its intervention in at least 15 partnering nursing facilities.

The goal of this Initiative is to:  

• Reduce the number of and frequency of avoidable hospital admissions and readmissions;
• Improve beneficiary health outcomes;
• Provide better transition of care for beneficiaries between inpatient hospitals and nursing facilities; and
• Promote better care at lower costs while preserving access to beneficiary care and providers.

Participants in the model – called “enhanced care and coordination providers” –will implement and operate their proposed interventions over a 4-year period.  Each participant is required to partner with a minimum of 15 Medicare-Medicaid certified nursing facilities in the same State where the intervention will be implemented. Nursing facility participation is voluntary.  

Participants proposed evidence-based interventions to accomplish the goals of the initiative in their applications to CMS.  The Initiative did not prescribe a specific clinical model for these interventions.  However, all proposed interventions must:  

• Improve beneficiary safety by better coordinating management of prescription drugs to reduce risk of polypharmacy and adverse drug events for residents, including inappropriate prescribing of psychotropic drugs.
• Bring onsite staff to collaborate and coordinate with existing providers, including residents’ primary care providers and the staff of the nursing facility. 
• Demonstrate a strong evidence base for the proposed intervention and potential for replication and sustainability in other communities and institutions across the country.
• Supplement (rather than replace) existing care provided by nursing facility staff.
• Allow for participation by nursing facility residents without any need for residents or their families to change providers or enroll in a health plan. Residents will be able to opt-out from participating, if they choose.

 CMS estimates that upon implementation, the awarded interventions will reach more than 17,000 beneficiaries over the four years of the Initiative.