CMS Announces New Pgm to Reduce Nursing Home Hospitalizations

The Centers for Medicare & Medicaid Services (CMS) has 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.

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, stated CMS in a fact sheet.

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.

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.
• Coordinate and improve management and monitoring of prescription drugs, including psychotropic drugs.

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.

Notices of Intent to Apply are due April 30, 2012. 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. 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.

It is interesting that solutions cannot come from the nursing home industry itself. I am sure some of the big chains are already looking at this issue on a System level. Why not share best practices? Or perhaps set up a consulting arm to help others? The application process seems burdensome considering all of the references that need to be gathered. Will be interesting to see who applies because in many ways these providers will be controlling many aspects of care and will become powerful players in the continuum.

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