Better Care, Less Hospitalizations for Nursing Facility Residents

Nursing facility residents may see some improvements in their care and experience less hospital admissions, as part of a new CMS initiative to reduce avoidable hospital admissions among these residents. 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.

CMS introduced this program in response to research showing that nursing facility residents often experience potentially avoidable inpatient hospitalizations. According to CMS, these hospitalizations are “expensive, disruptive, and disorienting for frail elders and people with disabilities.” Further, nursing facility residents tend to be especially vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and hospital-acquired infections.

“Being readmitted to a hospital is very difficult for low-income seniors, people with disabilities and their families,” said Acting Administrator Marilyn Tavennerin a recent CMS press release. “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.”

Additionally, 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.

To help reduce these costs and improve quality for nursing facility residents, CMS plans to collaborate with organizations (which CMS refers to as “enhanced care and coordination providers”) that will partner with nursing facilities to implement evidence-based interventions which will improve care and lower costs. Up to $128 million has been committed to the project by CMS to support a diverse portfolio of these interventions aiming to provide enhanced on-site services and supports to nursing facility residents. The organizations will then work with nursing facilities and states to provide coordinated, person-centered care with the goal of reducing avoidable hospital stays. Interventions from each participating organization will be implemented in at least 15 partnering nursing facilities.

Eligible organizations may include physician practices, care management organizations, and other entities. For-profit and not-for-profit organizations are eligible to apply. A “Request for Applications” was issued by CMS on Thursday, March 15. Organizations interested in participating in this initiative are required to submit an application no later than June 14, 2012.

As part of their application, those wishing to participate must propose an intervention that meets the objectives of the initiative. CMS will then select applications with the expectation that those interventions selected will then be implemented. Interventions will be evaluated for their effectiveness in improving health outcomes and providing residents with a better care experience. It is CMS’ plan that 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.

The initiative supports CMS’ Partnership for Patients’ goal of reducing hospital readmission rates by 20% by the end of 2013. Partnership for Patients is a public-private partnership aiming to cut preventable errors in hospitals by 40 percent and reduce preventable hospital readmissions by 20 percent over a three-year period.