This initiative is possible through the collaboration of the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office.
This effort aims to improve the quality of care for people residing in nursing facilities.
CMS supports organizations that each partner with a group of nursing facilities to implement evidence-based clinical and educational interventions that both improve care and lower costs. The initiative is focused on long-stay nursing facility residents who are enrolled in both the Medicare and Medicaid programs, with the goal of reducing potentially avoidable inpatient hospitalizations. This initiative was launched in 2012.
A second phase of this Initiative was announced on August 27, 2015. Under phase two, a new funding opportunity will allow the organizations currently participating in the Initiative to apply to test whether a new payment model for nursing facilities and practitioners, together with the current clinical and educational interventions in place under phase one, will reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents.
From a pool of applicants, 7 organizations were selected for phase one of this Initiative:Alabama Quality Assurance Foundation – Alabama expand Read more about
Alegent Health – Nebraska expand Read more about
HealthInsight of Nevada – Nevada expand Read more about
Indiana University – Indiana expand Read more about
The Curators of the University of Missouri – Missouri expand Read more about
The Greater New York Hospital Foundation, Inc. – New York City expand Read more about
UPMC Community Provider Services - Pennsylvania expand Read more about
Nursing facility residents often experience potentially avoidable inpatient hospitalizations. These hospitalizations are expensive, disruptive, and disorienting for seniors 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 individuals 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.
Since September 2012, under phase one of the Initiative, CMS has partnered with seven Enhanced Care and Coordination Provider (ECCP) organizations to improve care for long-stay nursing facility residents. In aggregate, the ECCPs collaborate with 144 nursing facilities across seven states to provide on-site staff for training and to provide preventive services and improve the assessment and management of medical conditions.
The intent of the new payment model under phase two of the Initiative is to reduce potentially avoidable hospitalizations by funding higher-intensity treatment services for residents who may otherwise be hospitalized upon an acute change in condition. Improving the capacity of nursing facilities to treat common medical conditions as effectively as possible in-house, as appropriate, has the potential to improve the residents’ care experience at lower cost than a hospital admission. The model also includes payments to practitioners (i.e., physicians, nurse practitioners and physician assistants) at levels similar to the payments they would receive for treating beneficiaries in a hospital. Practitioners would also be eligible to receive new payments for engagement in multidisciplinary care planning activities.
The four-year payment phase of the Initiative, slated to begin October 2016, will be subject to a rigorous external evaluation. Successful ECCP applicants will implement the payment model within their existing partner facilities, where they provide training and clinical interventions, and in a comparable number of newly recruited facilities.
- Phase Two Fact Sheet
- Phase Two Press Release
- Phase Two Solicitation (PDF)
- Phase One Fact Sheet (PDF)
- Phase One Frequently Asked Questions (PDF)
- Phase One Evaluation Report through December 2014 (PDF)
- Phase One Funding Opportunity Announcement (PDF) (modified 04/26/12)
- Phase One Webinar: Evidence-based Interventions
- Phase One Webinar: Overview
If you have additional questions on this Initiative, please e-mail NFI@cms.hhs.gov. Programmatic questions submitted after October 9, 2015 are not guaranteed a response. For more information on this initiative, including archived information, visit the Medicare-Medicaid Coordination Office page.