Federal Initiative to Focus on Care Coordination for Nursing Home Residents

The U. S. Centers for Medicare & Medicaid Services (CMS) unveiled a new program last week for reducing hospital admissions among nursing home residents.

Called the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents (RAHNFR), the program will apply to all people living in nursing homes who are enrolled in Medicare and Medicaid.

Currently, more than 1.5 million persons reside in nursing homes in the United States. Many of them are enrolled in both the Medicare and Medicaid programs. Research by CMS on Medicare-Medicaid enrollees in nursing facilities uncovered that approximately 45 percent of hospital admissions among those receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided, accounting for 314,000 potentially avoidable hospitalizations and $2.6 billion in Medicare expenditures in 2005.

Under the initiative, CMS is seeking to support organizations that will partner with nursing facilities to implement evidence-based strategies that will avoid or reduce hospitalizations.

These organizations might include physician practices, care management organizations, and other public and not-for-profit entities.

CMS refers to these organizations as “enhanced care & coordination providers.”

Nursing home residents are, by definition, in poor health, either physical or mental or both. Some are frail, some are physically robust but have severe cognitive impairments; often, in addition to a primary diagnosis (such as Alzheimer’s disease), nursing home residents will have other chronic health problems (co-morbidities) such as diabetes or heart failure, that put them at significant risk for a costly and life-threatening hospitalization.

Acting CMS Administrator Marilyn Tavenner said, “Through this initiative, we will work with nursing facilities and hospitals to provide better, person-centered care. By catching and resolving issues early, we can help people avoid costly and stressful hospitalizations.”

Why is the federal government embarking on this program?

Over the past several years, the Medicare program has learned that a significant percent of its beneficiaries are being readmitted to the hospital within 30 days of hospital discharge. Medicare pays the hospital for the first admission, and then pays again for the readmission.

This fall CMS will begin penalizing hospitals with high readmission rates and is designing care coordination programs to assist patients and their families with the difficult, confusing, and often chaotic transition from hospital to home or another medical facility such as a skilled nursing facility.

In addition to the “stick” wielded by the federal government against hospitals with high readmissions rates, the Affordable Care Act of 2010 also established “carrots” like the Medicare Shared Savings program, which rewards health care providers who reduce hospital admissions.

The RAHNFR Initiative is part of the CMS Partnership for Patients with goal to reduce hospital readmissions by 20 to 25 percent by 2013. This initiative is expected to last for four years from August 2012 to August 2016.

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