New models provide enhanced care in nursing homes

( A new Centers for Medicare & Medicaid Services initiative will test models to improve the quality of care and reduce avoidable hospitalizations of nursing facility residents by funding organizations that provide enhanced on-site services and support.

CMS on Sept. 27 announced seven cooperative agreement awards partnering with 145 nursing facilities to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. 

Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most also are enrolled in Medicare. These dual enrollees are among the most fragile and chronically ill individuals served by the programs, according to a CMS news release. Research has found that approximately 45% of hospitalizations among enrollees receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided. Total costs for these potentially avoidable hospitalizations of Medicare-Medicaid enrollees in 2011 were estimated at between $7 billion and $8 billion.

“We are excited about this partnership and the programs these seven organizations are putting in place to work with nursing facilities to ensure the best possible care for their residents,” CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA, said in a news release. “We view this initiative and the enhanced level of collaboration it will generate among a variety of providers as the key to reducing costly and avoidable hospitalizations for this population that often has the most complex healthcare needs.”

Through the initiative, CMS will partner with seven organizations, which will collaborate with nursing facilities and state Medicaid programs to provide better quality of care in nursing facilities.

Implementation of the initiative will begin later this year at 145 nursing facilities in seven states in partnership with the following organizations: Alabama Quality Assurance Foundation, Alegent Health (Nebraska), The Curators of the University of Missouri, Greater New York Hospital Foundation Inc., HealthInsight of Nevada, Indiana University and UPMC Community Provider Services (Pennsylvania).

Participants proposed evidence-based interventions to accomplish the goals of the initiative in their applications to CMS.

The initiative did not prescribe a specific clinical model for these interventions, but all proposed interventions must improve beneficiary safety by better coordinating management of prescription drugs to reduce risk of polypharmacy and adverse drug events for residents, including inappropriate prescribing of psychotropic drugs; bring onsite staff to collaborate and coordinate with existing providers, including residents’ primary care providers and staff of the nursing facility; and supplement (rather than replace) existing care provided by nursing facility staff.

For example, Indiana University will implement an intervention in 20 facilities in the Indianapolis area. The intervention includes the deployment of RNs and APRNs to be on-site at the nursing facilities, allowing for enhanced recognition and management of acute change in medical conditions. The RNs and APRNs will coordinate with nursing facility staff and residents’ primary care providers.

Each model will be subject to a rigorous external evaluation. The initiative will be run collaboratively by the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve healthcare quality and reduce costs in the Medicare and Medicaid programs. More information about the initiative is available at