Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents: Phase Two

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

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 long-term care (LTC) facilities by reducing avoidable hospitalizations.

CMS supports six organizations that each partner with a group of LTC facilities to implement evidence-based clinical and educational interventions that both improve care and lower costs. The Initiative is focused on long-stay LTC facility residents who are enrolled in both the Medicare and Medicaid programs, with the goal of reducing potentially avoidable inpatient hospitalizations.

The Initiative will allow CMS to test the payment model both on its own and in conjunction with the previously-developed clinical and educational interventions.

The intent of the new payment model is to reduce the financial incentive for hospitalization and provide funding for LTC facilities to provide treatment should a beneficiary experience an acute change in condition. LTC facilities are expected to invest the additional resources to implement programs and enhance the skills of staff in order to provide higher intensity services within the facility, thereby reducing avoidable hospitalizations.

Here are the latest evaluation reports for Phase 2:

Prior reports are available beneath the hyperlink in the 1st paragraph of this blog.

There’s a lot of information and detail in these reports.