The CMS announced Thursday that it is combating the skyrocketing cost of nursing home hospitalizations by injecting funds into the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.
In 2013, the CMS partnered with seven Enhanced Care and Coordination Providers in 144 nursing facilities across seven states to test a model to improve care for long-term residents.
The ECCPs provided training, preventive services and helped improve the assessment and management of medical conditions.
The new funding, slated to begin in October 2016, will allow the organizations currently participating in the initiative to apply to test whether a new payment model will further reduce avoidable hospitalizations, improve the quality of care and lower combined Medicare and Medicaid spending, the CMS said.
Successful ECCP applicants would implement the payment model into their existing partner facilities and at new facilities.
According to a 2013 report published by HHS' Office of Inspector General, $14.3 billion was spent on the hospitalization of nursing home residents in fiscal 2011.
“This initiative has the potential to improve the care for the most frail, most vulnerable Medicare-Medicaid enrollees—long-term residents of nursing facilities,” said Tim Engelhardt, director of the Medicare Medicaid Coordination Office. “By aligning financial incentives, we can improve the quality of on-site care in nursing facilities and the assessment and management of conditions that too often now lead to unnecessary and costly hospitalizations.”
The model also includes payments to providers similar to what they would receive for treating beneficiaries in a hospital. HealthInsight of Nevada, a private, not-for-profit community-based organization, is participating in ECCP. It recruited 25 Medicare-certified facilities from around the state, some in Las Vegas and some in rural areas as far as 250 miles away, said Deborah Huber, executive director of HealthInsight Nevada. The organization embedded an advanced practice registered nurse, physician assistant, and two registered nurses to integrate within nursing home staff, she said.
The goal of HealthInsight's model is to quickly recognize and intervene when a resident's condition changes, Huber said. The staff deployed to the nursing homes by HealthInsight helped identify eating and weight patterns and heart conditions of residents, and then recommended antibiotics that could be used to treat conditions earlier than before, she said.
A color system of green, yellow and red was developed, with green meaning “normal,” yellow denoting early intervention is needed on a condition and red meaning a resident's condition has declined and a trip to the hospital may be required, she said. An electronic registry, available to staff via laptops, documents the background and medical history of residents, she said.
The staff also makes sure conversations concerning end-of-life procedures happen with residents. “We are taking care of both acute-care and end-of-life spectrums,” Huber said.
Integrating HealthInsight's staff members took some time, Huber said. The nursing home staff had to learn to trust outsiders' opinions, and the HealthInsight's staff had to work at building relationships. To that end, HealthInsight hired a coach who has a doctorate in education and works at creating trust among the staffs. “That doesn't happen overnight,” she said.
Another participating ECCP, Indiana University, implemented the Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care program, or OPTIMISTIC. The collaborative-care program consists of 19 facilities that have registered nurses who work as liaisons and report back to OPTIMISTIC, said Dr. Kathleen Unroe, assistant professor of medicine at IU, and co-project director of the project.
The RN has advanced-care conversations with patients and provides patient mentoring at bedside. The RN also provides detailed root-cause analysis for every hospital transfer, Unroe said, and shares results with nursing homes.
Also, six nurse practitioners play a clinical role and facilitate hospital and nursing home transfers while providing collaborative-care reviews, she said.
While Unroe is excited by the opportunity the CMS initiative has provided with this additional funding, she said to really make a difference, the initiative needs to extend across the country.