Initiative to Reduce Avoidable Hospitalizations

For the past three years, CMS has partnered with 144 nursing facilities across seven states to test a model to reduce avoidable hospitalizations for long-stay residents of nursing facilities. The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents is a result of collaboration between the Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation. The initiative directly supports CMS’ ongoing work to reduce avoidable hospitalizations for Medicare-Medicaid enrollees and improve quality of care in post-acute and long-term care settings.

To launch the second phase CMS announced a new funding designed to enhance the Initiative to Reduce Avoidable Hospitalizations and Nursing Facility Residents. This funding allows for currently participating nursing facilities, practitioners, and organizations to test a new payment model that may further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by long-stay nursing facility residents.

The next phase is announcing the new payment model which is focused 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. This new four-year payment phase of the initiative is anticipated to begin October 2016. Improving the capacity for nursing facilities to treat medical conditions as effectively as possible on-site has the potential to improve the residents’ care experiences and lower hospital readmissions. The model also includes payment to practitioners (i.e., physician, nurse practitioners and physician assistants) that are 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

For more information regarding CMS’ initiative to reduce avoidable hospitalizations among nursing facility residents payment model, please visit CMS