CMS Announces 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. The Centers for Medicare & Medicaid Services (CMS) is currently accepting applications to participate in this initiative.

CMS will support organizations that will partner with nursing facilities to implement evidence-based interventions that both improve care and lower costs.  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. This initiative supports the Partnership for Patients' (http://innovation.cms.gov/initiatives/Partnership-for-Patients/index.html) goal of reducing hospital readmission rates by 20% by the end of 2013.

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). 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 Details

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. Interventions will be evaluated for their effectiveness in improving health outcomes and providing residents with a better care experience.

Addition Information is available at the following links:

Questions about this initiative can be referred to MedicareMedicaidCoordination@cms.hhs.gov.