Society Members Share Encouraging Results From Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents

Several Society members who have been participating in The Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents, that was launched in 2012 by the Centers for Medicare & Medicaid Services (CMS), are encouraged by a recent report showing the project is making a difference. CMS launched this project in an effort to improve the quality of care for people residing in long-term care (LTC) facilities by reducing avoidable hospitalizations by using evidence-based clinical and educational interventions among long-stay residents in 143 facilities in seven states (Alabama, Nebraska, Nevada, Indiana, Missouri, New York, Pennsylvania).

CMS partnered with seven Enhanced Care and Coordination Provider (ECCP) organizations to provide on-site staff for training and to provide preventive services and improve the assessment and management of medical conditions to reduce avoidable hospitalizations.

In an article published in the current issue of Health Affairs, analysis of the data from the initiative show a net reduction in 2016 of 2.2-9.3 percentage points in the probability of an all-cause hospitalization and 1.4-7.2 percentage points in the probability of a potentially avoidable hospitalization for participating facility residents, relative to comparison-group members.

The data found that in 2015 the average per resident Medicare expenditures were reduced by $60–$2,248 for all-cause hospitalizations and by $98–$577 for potentially avoidable hospitalizations. The effects for over half of the outcomes in these analyses were significant.

In what may be the most significant study in nursing homes in quite a while, Society leader Charles Crecelius, MD, PhD, CMD, states that “It is gratifying to know we can reduce total and unnecessary hospitalizations while maintaining quality and reducing costs. These projects are sustainable and may be a starting point for new bundle or alternative payment models (APMs)”. He notes that Missouri is one of the leaders in improving quality and reducing cost as part of the this project.

These results could serve a blueprint for the development of meaningful and PALTC specific APMs, one of the tracks available in the new MACRA payment model.

Dr. Crecelius plans to provide a deeper dive into the project at the Society’s upcoming Annual Conference that takes place March 16-19 in Phoenix, Arizona. For more information, click here.

A second phase of this Initiative was announced on August 27, 2015, and new cooperative agreements were announced on March 24, 2016.