In 2012, the Centers for Medicare and Medicaid Services launched the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, the idea being that slashing these hospitalizations would benefit patients while also lowering costs for Medicare and Medicaid. According to research published in the journal Health Affairs, the program has shown promising results.
Examining the 143 facilities in seven states that participated in the program, researchers found net reductions in 2015 of 2.2 to 9.3 percent in the probability of an all-cause hospitalization, and and a 1.4 to 7.2 percent reduction in avoidable hospitalizations among residents in the participating facilities.
In that year, average per-resident Medicare expenditures were reduced by $98 to $577 for potentially avoidable hospitalizations. There were benefits to the staffs of these facilities as well -- they exhibited higher staff engagement and better clinical outcomes.
CMS' initiative was launched in late 2012 in response to the cost of avoidable hospitalizations to Medicare ad Medicare. One 2005 study reported that about 47 percent of hospitalizations among nursing facility residents were avoidable, with an estimated cost to Medicare and Medicaid of $1.9 billion. Using a competitive process, CMS selected seven Enhanced Care and Coordination Provider organizations to design and implement interventions to cut into avoidable hospitalizations.
One of the required elements of these ECCP organizations was to hire staff that could focus on things like medication management, and improving communication and coordination among staff members, residents' primary care providers and specialists, pharmacies and hospitals.
The data suggests the approach is working, to varying degrees of success. Of the participating states -- Missouri, Indiana, Pennsylvania, Nevada, Alabama, New York and Nebraska -- Missouri and Indiana demonstrated consistently favorable results that were statistically significant. Pennsylvania and Nevada showed positive results that were somewhat less consistent the remaining three states showed positive results that weren't necessarily statistically significant.
That backs up previous studies showing that skilled staff members can provide preventative care in the facility, and treat ailments promptly, instead of relying on emergency services. They're also able to prevent unnecessary hospitalizations at a lower salary expense compared to physician staff members.
Unlike some of CMS' other initiatives, this one did not provide financial incentives to providers, only education and assistance. But the study's authors say a second phase is coming. Medicare will soon pay participating nursing facilities and their partnering practitioners for treating residents with particular conditions in the facility, as opposed to sending them to the hospital.