Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents

This initiative is possible through the collaboration of the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office.

This effort aimed to improve the quality of care for people residing in long-term care (LTC) facilities by reducing avoidable hospitalizations.

CMS supported organizations that each partnered with a group of LTC facilities to implement evidence-based clinical and educational interventions that both improved care and lowered costs. The initiative was focused on long-stay LTC facility residents who were 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, and new cooperative agreements were announced on March 24, 2016.

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From a pool of applicants, 7 organizations were selected for phase one of this Initiative:

Alabama Quality Assurance Foundation – Alabama
CHI/Alegent Creighton Health – Nebraska
HealthInsight of Nevada – Nevada
Indiana University – Indiana
The Curators of the University of Missouri – Missouri
The Greater New York Hospital Foundation, Inc. – New York City
UPMC Community Provider Services - Pennsylvania

Background

LTC facility residents often experience potentially avoidable inpatient hospitalizations. These hospitalizations are expensive, disruptive, and disorienting for seniors and people with disabilities. LTC facility residents are especially vulnerable to the risks that accompany hospital stays and transitions between LTC facilities and hospitals, including medication errors and hospital-acquired infections.

Many LTC facility residents are enrolled in both the Medicare and Medicaid programs (Medicare-Medicaid enrollees). CMS research on Medicare-Medicaid enrollees in LTC 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.

Initiative Details

Under the initial phase of the Initiative, CMS partnered with seven Enhanced Care and Coordination Provider (ECCP) organizations to improve care for long-stay LTC facility residents. In aggregate, the ECCPs collaborated with 143 LTC 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 to reduce avoidable hospitalizations.

The ECCPs collaborated with States and LTC facilities, with each ECCP implementing its evidence-based interventions in at least 14 partnering LTC facilities over a four-year period (2012-2016). The interventions in the first phase of the Initiative reached about 16,000 beneficiaries each month.

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

Applications for this Initiative were due June 14, 2012.

Additional Information

If you have additional questions on this Initiative, please e-mail NFI@cms.hhs.gov. For more information on this initiative, including archived information, visit the Medicare-Medicaid Coordination Office page.