It’s not uncommon for nursing home residents to have inpatient hospital stays, but the frequency of these visits is a growing concern for the Centers for Medicare and Medicaid Services (CMS). The problem isn’t that nursing home residents sometimes require acute inpatient services, but rather the fact that so many hospital stays are avoidable. Hospital visits are, of course, quite expensive, so this places unnecessary financial strain on the already fragile Medicare and Medicaid systems.
In 2005, CMS determined that 314,000 inpatient hospital stays for skilled nursing residents were potentially avoidable, creating $2.6 billion in unnecessary expenses. In response to this increasing problem, CMS has launched a demonstration project to create programs that can reduce the number of unnecessary hospital visits and save the system billions of dollars, according to Healthcare Finance News.
About 150 skilled nursing facilities with high hospitalization rates and a high percentage of Medicare/Medicaid dual eligibles will receive intervention services from third-party independent organizations selected by CMS. Currently, no independent partners have been announced and CMS will continue to accept proposals through July 29th.
Partner Competition is Stiff
Organizations wanting to participate in the project have their work cut out for them. A number of strict requirements have been set forth by CMS, including evidence-based results, coordination of care and communication strategies reaching patients, families and communities. Prevention is also heavily emphasized, such as reducing urinary tract infections, adverse drug interactions, falls, pressure ulcers and dehydration–all common complications in nursing home residents that often lead to inpatient hospital stays.
Programs may include the use of nurse practitioners and will also emphasize transitioning residents between nursing homes and acute care facilities. Organizations selected for the project will work under a 12-month contract, which can be extended for three additional 12-month periods pending the success of the programs.
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