Medicare-Medicaid Announces Initiative to Reduce Avoidable Hospitalizations among Nursing Home Residents

By Editor, on March 16th, 2012

Initiative to Improve Nursing Home Care & Prevent Avoidable Hospital Admissions The U.S. Centers for Medicare & Medicaid Services (CMS) announced a new initiative on March 15, 2012 aimed at reducing avoidable hospitalizations among nursing home residents who are dual Medicare-Medicaid beneficiaries.

“The initiative aims to reduce costly and avoidable hospitalizations among nursing facility residents by funding organizations that would partner with nursing facilities to provide enhanced on-site services and supports to nursing facility residents,” CMS states in its announcement. “CMS commits up to $128 million to support a diverse portfolio of these evidence-based interventions,” according to the announcement.

Background

In its announcement, CMS cites a study which “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.”

“The study also found that five conditions were responsible for 78% of the potentially avoidable hospitalizations: pneumonia, congestive heart failure, urinary tract infections, dehydration, and chronic obstructive pulmonary disease/asthma,” according to background information contained in a a 74 page information document issued by CMS for the new initiative.

“Nursing facility residents are subject to frequent avoidable inpatient hospitalizations. These hospitalizations are expensive, disruptive, disorienting, and often dangerous for frail elders and people with disabilities,” CMS states in background information contained in the 74 page information document for the new initiative. “Nursing facility residents are especially vulnerable to the risks that accompany hospitalizations and transitions of care, including medication errors and hospital-acquired infections. Hospital episodes are even more difficult for individuals with dementia. Thus, preventing avoidable hospitalizations of nursing facility residents is an important quality-improvement objective, which may yield cost reductions as well,” the CMS document states.

“Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most are also enrolled in Medicare,” according to CMS’ announcement of the new initiative. “Many are enrolled in both programs. These Medicare-Medicaid enrollees are among the most vulnerable individuals served by the programs and generally have the most complex health care needs.” Accordingly, this initiative targets assistance to those nursing home residents who are dual Medicare-Medicaid beneficiaries.

The new initiative “aims to reduce costly and avoidable hospitalizations among nursing facility residents by funding organizations that would partner with nursing facilities to provide enhanced on-site services and supports to nursing facility residents,” CMS states in announcing the initiative. “This new initiative works to prevent potentially avoidable hospitalizations by providing better, more cost-effective care in nursing facilities.”

The New Initiative; Grant Applications

As part of the new initiative, CMS will accept applications from private sector and nonprofit organizations for grants totaling in the aggregate up to $128 Million plus $6.4 Million of Supplementary funding over 4 years. Each applicant must design and propose to administer a program to work in collaboration with at least 15 Medicare-Medicaid certified nursing homes, to enhance and coordinate care in ways that can measurably reduce avoidable hospital admissions and improve health outcomes for nursing home residents, and reduce overall health care spending. Each program must also be approved by the applicable State(s).

The private sector and nonprofit organizations who may apply for grants under this program are referred to as “Enhanced Care & Coordination Providers.” Organizations eligible to apply include physician practices, care management organizations, and other public and not-for-profit entities.

Each applicant to become an Enhanced Care & Coordination Provider “will propose its own evidence-based intervention and improvement strategy,” CMS explains. The proposed interventions (programs) must meet the objectives of the initiative, which those selected will then implement.

In its announcement, CMS states that “All enhanced care & coordination providers in this initiative must:

Hire staff who maintain a physical presence at nursing facilities and partner with nursing facility staff to implement preventive services;
Work in cooperation with existing providers;
Facilitate residents’ transitions to and from inpatient hospitals and nursing facilities;
Provide support for improved communication and coordination among existing providers; and
Coordinate and improve management and monitoring of prescription drugs, including psychotropic drugs.

“For example,” CMS explains, “past demonstrations have reduced avoidable hospitalizations by deploying nurse practitioners in nursing facilities to manage residents’ medical needs on the spot, when possible. Others have implemented quality improvement and communications tools to identify, assess, communicate, and document changes in resident status.”

Filing Deadlines and Timeline

Applicants for the grants must file a Notice of Intent to Apply by April 30, 2012, and must file the application by June 14, 2012.

CMS anticipates that the awards will be announced by August 24, 2012, and the programs selected to participate in the initiative will be implemented and funded over the four year period from August 25, 2012 through August 24, 2016.

Further Information About the Initiative

Following is a Fact Sheet issued by CMS regarding the new initiative:

FACT SHEET

FOR IMMEDIATE RELEASE Contact: CMS Media Relations Group

March 12, 2011 (202) 690-6145

New Opportunity for Better Care for Nursing Facility Residents through Enhanced Coordination Efforts

CMS Announces New Initiative to Reduce Costly and Avoidable Hospitalizations Announcement of Request for Applications

Overview

In March 2012, the Centers for Medicare & Medicaid Services (CMS) issued a request for applications to participate in 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.

CMS will support organizations that will partner with nursing facilities to implement evidence-based interventions to improve the quality and costs of care. 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.

Background

Too often, nursing facility residents 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 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.

Initiative

Through this initiative, CMS will partner with eligible, independent, non-nursing facility organizations (referred to as “enhanced care & coordination providers”) to implement evidence-based interventions that reduce avoidable hospitalizations. Eligible organizations can include physician practices, care management organizations, and other public and not-for-profit entities.

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.

Applicants will propose an intervention that meets the objectives of the initiative, which those selected will then implement. All enhanced care & coordination providers in this initiative must:

Hire staff who maintain a physical presence at nursing facilities and partner with nursing facility staff to implement preventive services;
Work in cooperation with existing providers;
Facilitate residents’ transitions to and from inpatient hospitals and nursing facilities;
Provide support for improved communication and coordination among existing providers; and
Coordinate and improve management and monitoring of prescription drugs, including psychotropic drugs.

For example, past demonstrations have reduced avoidable hospitalizations by deploying nurse practitioners in nursing facilities to manage residents’ medical needs on the spot, when possible. Others have implemented quality improvement and communications tools to identify, assess, communicate, and document changes in resident status.

Interventions will be evaluated for their effectiveness in improving health outcomes and providing residents with a better care experience. This initiative is expected to last for four years from August 2012 to August 2016.

Application Process

Organizations interested in applying to participate in this initiative must submit a proposal by June 14, 2012. The Request for Applications is available by searching for CFDA Number 93.621 at www.grants.gov. Applicants must include letters of support from the relevant State Medicaid Director and State Survey & Certification Director and letters of intent from at least 15 nursing facility partners in the same State. Notices of Intent to Apply are due April 30, 2012.

CMS will give preference to applications for initiatives in geographic locations where there are high Medicare costs, high hospital readmission rates, and where Medicare-Medicaid enrollees account for a high percentage of nursing facility residents.

Additional Information

This initiative was developed jointly by the CMS’ Center for Medicare and Medicaid Innovation (Innovation Center) and the Medicare-Medicaid Coordination Office, which were created by the Affordable Care Act. Both offices offer various opportunities and supports to further efforts to strengthen the Medicare and Medicaid programs and improve care. The Innovation Center works across the Medicare and Medicaid programs and Children’s Health Insurance Program to deliver better care for individuals, better health for populations, and lower growth in expenditures. The Medicare-Medicaid Coordination Office works to better integrate the Medicare and Medicaid programs to ensure full access to seamless, high-quality care in a cost-effective manner.

Please see: http://innovation.cms.gov/initiatives/rahnfr for more information about the initiative.”

According to the 74 page information document released by CMS regarding the new initiative, “The activities [in this initiative] support the goals of the Partnership for Patients, a national public-private partnership to help improve the quality, safety, and affordability of health care for all Americans. Both this [initiative] and the Partnership for Patients aim to reduce hospital readmissions.” More information about the Partnership for Patients program can be found at: http://innovations.cms.gov.

The new initiative also supports the Million Hearts Campaign, according to CMS. The Million Hearts Campaign is a national initiative to prevent one million heart attacks and strokes over the next five years. More information about the Million Hearts Campaign can be found at: http://millionhearts.hhs.gov.