The American Health Lawyers Association (”AHLA”) noted today the following:  CMS Launches Initiative To Reduce Avoidable Hospitalizations Among Nursing Home Residents 

The Centers for Medicare & Medicaid Services (CMS) announced September 27 cooperative agreement awards to implement a new initiative aimed at reducing avoidable hospitalizations among nursing facility residents.

The awards to seven organizations—Alabama Quality Assurance Foundation (Alabama), Alegent Health (Nebraska), the Curators of the University of Missouri (Missouri), Greater New York Hospital Foundation, Inc. (New York), HealthInsight of Nevada (Nevada), Indiana University (Indiana), and UPMC Community Provider Services (Pennsylvania)—will provide funding for enhanced onsite services and supports to nursing facility residents, according to CMS’ press release.

The initiative is focused on long-stay nursing facility residents who are enrolled in the Medicare and Medicaid programs, known as dual eligibles.

CMS cited research showing roughly 45% of hospitalization among dual eligibles receiving either skilled nursing facility or nursing facility services were avoidable, representing an estimated $7 billion to $8 billion in costs.  

“We are excited about this partnership and the programs these seven organizations are putting in place to work with nursing facilities to ensure the best possible care for their residents,” said Acting CMS Administrator Marilyn Tavenner.

The selected organizations will work with 145 nursing facilities in seven states.

The organizations will have staff onsite to partner with existing nursing facility staff to provide preventive services as well as improve assessments and management of medical conditions, CMS said.

The organizations will focus on seamless beneficiary transitions of care and leveraging emerging technologies, among other efforts.

Each state will implement the program differently.  According to CMS, the Curators of the University of Missouri will partner with 16 nursing facilities in Missouri using advanced practice RNs (APRNs) and social workers.  The APRNs will be assigned to facilities to provide direct services to residents, and mentor, role-model, and educate the nursing staff about early symptom/illness recognition, assessment, and management of health conditions commonly affecting nursing home residents.  The social workers will work closely with each facility’s social worker, the residents’ primary care providers, nursing facility staff, and APRN to enhance consistent communication about resident’s needs and preferences.

Finally, RNs will implement INTERACT and QIPMA (Quality Improvement Program for Missouri), programs that have demonstrated positive results in the nursing facility environment.  Nebraska will partner with 15 nursing facilities, also using APRNs. They will focus on enhancing care by implementing INTERACT tools and a program to improve medication management based on the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.  Nebraska will also use a dentist and dental hygienist to improve the residents’ oral care. 

Our Insight.  Your Advantage Avoidable hospitalizations will have a significant impact on payments to hospitals and eventually SNFs.  Hospitals will be reluctant to partner with skilled nursing facilities (SNFs) with high avoidable hospitalization rates for its residents. SNFs in these seven states should take advantage of this opportunity to partner with the institutions awarded the grants.  Cooperative efforts between hospitals and SNFs can improve the quality of care for the patients/residents and increase the bottom line for all.  Husch Blackwell has attorneys with significant experience working with hospitals and skilled nursing facilities, including a number with clinical degrees and experience.  Our healthcare team can assist providers in successful partnering.