CMS Launches Initiative to Reduce Hospitalization from Nursing Facilities

The Centers for Medicare & Medicaid Services (CMS) announced on Thursday the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, meant to improve care for Medicare or Medicaid beneficiaries in nursing facilities.

The new initiative aims to reduce costly and avoidable hospitalizations of nursing facility residents by funding organizations that would partner with the nursing facilities to provide enhanced on-site services and supports to residents.

CMS says it’s committing up to $128 million to support a diverse portfolio of these evidence-based interventions, and the effort 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 quality and costs of care in both programs.


“Being readmitted to a hospital is very difficult for low-income seniors, people with disabilities and their families,” said Acting Administrator Marilyn Tavenner. “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.”

Independent organizations will have the opportunity to partner up with CMS to improve care for long-stay nursing home residents, and they’ll collaborate with both facilities and states to provide coordinated, person-centered care with a goal of reducing avoidable hospitalizations.

Eligible organizations include physician practices, care management organizations, and other public and not-for-profit entities. Interested organizations will need to propose their own evidence-based intervention and improvement strategies, and each would have its staff on-site at the facility to provide preventive services and improve coordination and communication among providers to help give the resident smooth transitions between care settings.


Past demonstrations have reduced avoidable hospital stays by deploying nurse practitioners in nursing facilities to manage residents’ medical needs on the spot, when possible, says CMS, while others have implemented quality improvement and communications tools to identify, assess, communicate, and document changes in resident status.

Industry trade group the American Health Care Association supports the CMS Initiative and agrees that skilled nursing centers must do more to prevent hospital readmissions among patients.

“AHCA is a proud member of Partnership for Patients and created our own Quality Initiative, to proactively challenge our membership to reduce rehospitalizations 15% by 2015,” says Dr. David Gifford, MPH, SVP of Quality and Regulatory Affairs at AHCA. “AHCA looks forward to continuing to work with CMS on this important issue as we attempt find innovative ways for providers to prevent sending vulnerable seniors back to the hospital.”

A majority of nursing home residents (nearly two-thirds) are enrolled in Medicaid, and many are also enrolled in Medicare. The “vulnerable” population served by both programs generally have the most complex health care needs, says CMS.

“Research on these enrollees in nursing facilities found that approximately 45% 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,” says the Center. “This new initiative works to prevent potentially avoidable hospitalizations by providing better, more cost-effective care in nursing facilities.”

The initiative is expected to last for four years from August 2012 through 2016. For more information, along with the Request for Applications, click here.

Written by Alyssa Gerace

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