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CMS calls pilot program to cut readmissions a success

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The Centers for Medicare & Medicaid Services says that experiment seeking to cut  avoidable hospitalizations of elderly nursing-home residents has worked well,  generating nearly $50 million in savings. The three-year pilot program, called the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, achieved a 17 percent relative reduction in potentially avoidable hospitalizations in participating facilities. CMS reported.

“These findings provide persuasive evidence of the initiative’s effectiveness in reducing hospital inpatient admissions, ED visits and hospitalization-related Medicare expenditures,” its  report said.

Modern Healthcare reported that under the model, “third-party organizations known as enhanced care and coordination providers, or ECCPs, hired nurses to provide education and clinical support to nursing home staff and help keep residents out of the hospital. All in all, 143 nursing homes in seven states as well as health systems, universities and consultants participated in the program, which ran from 2012 to 2016.”

“Health systems that participated in the experiment as ECCPs praised the initiative, even though it aimed to reduce inpatient traffic, which could affect their bottom line. The providers acknowledged that it can be better to keep patients in surroundings they know.”

“The experiment could lead to a sea change in how nursing homes care for patients, where the facilities catch ailments early and address them in-house rather than sending residents to the hospital, according to Tim Johnson, executive director of the Greater New York Hospital Association Foundation, which served as the ECCP for New York.”

“Most clinicians have been trained to believe that the hospital is the best place for anyone with an acute change of condition,” Mr.. Johnson told Modern Healthcare. “This belief can result in what turn out to be avoidable hospitalizations.”

“Initiative participants have moved on to the second phase of the model, which pays nursing homes at Medicare rates to treat patients with one of six specific ailments in their facilities and out of hospitals.

“The six conditions—pneumonia, dehydration, congestive heart failure, urinary tract infections, skin ulcers and asthma—are linked to approximately 80% of potentially avoidable hospitalizations among long term care facility residents, according to the CMS.”

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