CMS NEWS
FOR IMMEDIATE RELEASE
August 27,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS to Extend Initiative to Improve Care
for Nursing Facility Residents
Funding would allow testing of new
payment model for nursing facility care
The Centers for Medicare & Medicaid Services (CMS) today announced a
new funding opportunity designed to enhance the Initiative to Reduce
Avoidable Hospitalizations among Nursing Facility Residents. The 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 will further reduce avoidable hospitalizations, lower combined
Medicare and Medicaid spending, and improve the quality of care received by
nursing facility residents.
For the past three years, CMS has partnered with seven Enhanced Care and
Coordination Providers (ECCPs) to test a model to improve care for long-stay
nursing facility residents. The ECCPs collaborate with 144 nursing facilities
across seven states—Alabama, Indiana, Missouri, Nebraska, New York, Nevada, and
Pennsylvania—to provide on-site staff for training, to provide preventive
services, and to improve the assessment and management of medical conditions
(see fact sheet).
The intent of the new payment model is to reduce avoidable
hospitalizations by funding higher-intensity interventions in nursing
facilities for residents who may otherwise be hospitalized upon an acute change
in condition. Improving the capacity of nursing facilities to treat medical
conditions as effectively as possible within the facility 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) similar to the payments they would
receive for treating beneficiaries in a hospital. Practitioners would also
receive new payments for engagement in multidisciplinary care planning
activities.
“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.”
This new four-year payment phase of the Initiative, slated to begin
October 2016, will be subject to a rigorous external evaluation to determine
the effects on cost and quality of care. Successful ECCP applicants would
implement the payment model with both their existing partner facilities, where
they provide training and clinical interventions, and in a comparable number of
newly recruited facilities.
The Initiative is a collaboration of the CMS Medicare-Medicaid
Coordination Office and the Center for Medicare and Medicaid Innovation, both
created by the Affordable Care Act to improve health care quality and reduce
costs in the Medicare and Medicaid programs. The Initiative complements broader
administration efforts to improve long term care facilities, including proposed
updates to the conditions of participation for nursing homes, improvements to
the five star rating system for consumers, and implementation of the new
Skilled Nursing Facility Quality Reporting Program that ties skilled nursing
facility payment to the reporting of quality measures.
Click here to view the CMS Fact sheet issued: http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-08-27.html
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