Funding would allow testing of new payment model for nursing facility care

Angie Szumlinski
October 5, 2015

The Centers for Medicare &
Medicaid Services (CMS) today announced a new funding opportunity designed to
enhance the Initiative to
Reduce Avoidable Hospitalizations among Nursing Facility Residents
The funding opportunity will allow the organizations currently participating in
the Initiative to apply to test whether a new payment model for nursing
facilities and practitioners will further reduce avoidable hospitalizations,
lower combined Medicare and Medicaid spending, and improve the quality of care
received by nursing facility residents.

For the past three years, CMS
has partnered with seven Enhanced Care and Coordination Providers (ECCPs) to
test a model to improve care for long-stay nursing facility residents. The
ECCPs collaborate with 144 nursing facilities across seven states—Alabama,
Indiana, Missouri, Nebraska, New York, Nevada, and Pennsylvania—to provide
on-site staff for training, to provide preventive services, and to improve the
assessment and management of medical conditions (see fact sheet).

The intent of the new payment
model is 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. Improving the capacity of nursing facilities
to treat medical conditions as effectively as possible within the facility has
the potential to improve the residents’ care experience at lower cost than a
hospital admission. The model also includes payments to practitioners (i.e.,
physicians, nurse practitioners and physician assistants) 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.

“This Initiative has the
potential to improve the care for the most frail, most vulnerable
Medicare-Medicaid enrollees—long term residents of nursing facilities,” said
Tim Engelhardt, Director of the Medicare Medicaid Coordination Office. “By
aligning financial incentives, we can improve the quality of on-site care in
nursing facilities and the assessment and management of conditions that too
often now lead to unnecessary and costly hospitalizations.”

This new four-year payment
phase of the Initiative, slated to begin October 2016, will be subject to a
rigorous external evaluation to determine the effects on cost and quality of
care. Successful ECCP applicants would implement the payment model with both
their existing partner facilities, where they provide training and clinical
interventions, and in a comparable number of newly recruited facilities.

The Initiative is a
collaboration of the CMS Medicare-Medicaid Coordination Office and the Center
for Medicare and Medicaid Innovation, both created by the Affordable Care Act
to improve health care quality and reduce costs in the Medicare and Medicaid
programs. The Initiative complements broader administration efforts to improve
long term care facilities, including proposed updates to the conditions of
participation for nursing homes, improvements to the five star rating system
for consumers, and implementation of the new Skilled Nursing Facility Quality
Reporting Program that ties skilled nursing facility payment to the reporting
of quality measures.

Click here to view the CMS Fact
sheet issued:

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