CMS NEWS
FOR IMMEDIATE RELEASE
March 24, 2016
Contact: CMS Media Relations
CMS
Launches New Effort to Improve care for Nursing Facility Residents
New
payment model test for nursing facility care aims to reduce avoidable
hospitalizations
The Centers for Medicare & Medicaid Services (CMS) today announced it
will 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.
This next phase of the Initiative to Reduce Avoidable Hospitalizations
among Nursing Facility Residents seeks to reduce avoidable hospitalizations
among beneficiaries eligible for Medicare and/or Medicaid by providing new
payments to practitioners for engagement in multidisciplinary care planning
activities. In addition, the participating skilled nursing facilities will
receive payment to provide additional treatment for common medical conditions
that often lead to avoidable hospitalizations.
Through this model, CMS would facilitate practitioner engagement when a
nursing facility resident needs higher-intensity interventions due to an acute
change in condition. Medicare currently pays physicians less for a
comprehensive assessment at a skilled nursing facility than for the same
assessment at a hospital. This model would equalize the payments between the sites
of care. Removing potential barriers to effective treatment within a facility
can improve the residents’ care experience and mitigate the need for disruptive
and costly hospitalizations. For example, participating skilled nursing
facilities will be expected to enhance their staff training and purchase new
equipment to improve their capacity to provide intravenous therapy and cardiac
monitoring.
“This Initiative has the potential to improve the care for the most frail,
most vulnerable Medicare-Medicaid enrollees—long-stay residents of nursing
facilities,” said Tim Engelhardt, Director of the Medicare-Medicaid
Coordination Office. “Smarter spending 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.”
Since 2012, CMS has funded Enhanced Care and Coordination Providers
(ECCPs) to test a model to improve care for long-stay nursing facility
residents through clinical and educational interventions. The ECCPs currently
collaborate with 143 long-term care facilities to provide on-site staff for
training and preventive services and to improve the assessment and management
of medical conditions. Early results from the first phase of the Initiative are
promising, according to an
independent
evaluation. All seven sites generally showed a decline in all-cause
hospitalizations and potentially avoidable hospitalizations, with four sites
showing statistically significant reductions in at least one of the
hospitalization measures. In addition, all sites generally showed reductions in
Medicare expenditures relative to a comparison group in 2014, with
statistically significant declines in total Medicare expenditures at two sites.
This first phase of the Initiative will continue through 2016.
This new four-year payment phase of
the Initiative, slated to begin fall 2016, will be implemented through
cooperative agreements with six ECCPs. The six awardees are:
- Alabama Quality Assurance Foundation – Alabama
- HealthInsight of Nevada – Nevada and Colorado
- Indiana University – Indiana
- The Curators of the University of Missouri –
Missouri
- The Greater New York Hospital Foundation, Inc. –
New York
- UPMC Community Provider Services – Pennsylvania
The new model will be subject to a rigorous independent evaluation to
determine the effects on cost and quality of care. ECCP awardees will implement
the payment model with both their existing partner facilities, where they
provide training and clinical interventions, and in a comparable number of
additional facilities to be recruited over the next several months.
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 test payment models 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.
For more information on this Initiative,
including both current activities and this new phase, please visit: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/InitiativetoReduceAvoidableHospitalizations/AvoidableHospitalizationsamongNursingFacilityResidents.html