CMS Launches Initiative to Reduce Nursing Home Resident Hospitalizations

Earlier this year, the Centers for Medicare and Medicaid Services (CMS) announced its Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents, a partnership between the agency and seven organizations to decrease the number of avoidable hospitalizations of Medicare-Medicaid enrollees or “dual eligibles.” On September 27, CMS revealed which organizations it would be partnering with and to which it would be issuing cooperative agreement awards. The chosen organizations are as follows: Alabama Quality Assurance Foundation; Alegent Health; The Curators of the University of Missouri; Greater New York Hospital Foundation, Inc.; HealthInsight of Nevada; Indiana University; and UPMC Community Provider Services.

When the initiative begins, later in 2012, staff members from the selected organizations will partner with nursing staff on-site of 145 nursing facilities located in each of their seven states. They will work together to improve beneficiary health incomes and achieve more seamless transitions of care for patients who move between hospitals and the nursing facilities.

Each of the seven organizations were chosen based on submissions of proposed evidence-based interventions they believe will accomplish the goals of the initiative. Interventions must not replace existing nursing care, but act as a supplement to that care. They must address the coordination of patients’ prescription drugs to reduce adverse events related to the drugs and must specifically deal with improper prescribing of psychotropic drugs. The organizations must demonstrate that their intervention is adoptable in nursing facilities nationwide, and the intervention must allow residents to continue receiving care from their existing primary care practitioners.

CMS has targeted “dual eligibles” in this initiative because they tend to present the most intricate cases and to suffer from chronic illnesses. Care for this patient population becomes unnecessarily costly due to the lack of efficiency proposed by navigating multiple program rules and providers. Evidence has shown that an estimated 45 percent of hospitalizations of “dual eligibles” are avoidable; each year, care for these beneficiaries cost CMS over $300 billion. CMS estimates that the interventions staged by this initiative will reach nearly 17,000 beneficiaries.