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CMS Program to Lower Hospital Readmission Rates

As discussed earlier this week, the federal Centers for Medicare and Medicaid Services (CMS) is in a position to exert significant influence over quality of care at nursing homes. That is because most facilities depend on receiving payment from the CMS programs covering seniors without the means to pay for nursing home care on their own. For this reason, CMS has requirements, incentives, and programs aimed and getting facilities to provide better care to both improve senior lives and lower overall long-term care costs.

Minimizing Nursing Home Neglect
For example, last week CMS officials announced the start of a new program aimed at lowering avoidable hospitalizations of nursing home residents. When senior residents are abused or neglected, they often require hospitalization to treat the consequences of the mistreatment. It is not uncommon for those hospitalizations to drag on, as senior bodies are often frail–complications are common. Those hospitalizations are quite expensive. Minimizing readmissions to hospitals is therefore a key cost-containment effort.

According to the press release announcing the new CMS program, the Center is starting a new initiative with 145 long-term care facilities. The program “will test models to improve the quality of care and help reduce avoidable hospitalizations among nursing facility residents by funding organizations that provide enhanced on-site services and support to nursing facility residents.”

As part of the initiative CMS will partner with seven separate organizations to implement various techniques. Each partner organization represents a group within a different state. Illinois is currently not participating in this effort. However, depending on the success of each effort, it is likely that certain aspects of the trials will be rolled out nationwide, affecting nursing homes in Chicago and throughout Illinois.

CMS officials explain that the seven organizations will have staff on-site at each of the 145 participating nursing facilities. They staff members will “provide preventatives services as well as improve assessments and management of medical conditions.”

A key component of the effort will involve better transitions of care. Many seniors experience significant problems when first moving from the hospital to the nursing home and vice versa. In addition, new technologies to monitor care and identify problems early-on will be leveraged. As with all medical treatment, preventative care for seniors is far cheaper than emergency services.

All of these efforts will be vigorously monitored using external evaluations. The idea, of course, is to determine conclusively which programs work and which ones don’t. The winners will be saved and likely applied in facilities across the country.

It is no wonder why CMS is taking this step. According to the release, nearly 45% of all hospitalizations among those who are dual Medicare-Medicaid enrollees (usually the most chronically ill seniors) is avoidable. This represents a huge unnecessary financial expenditure. According to CMS estimates, if those avoidable hospitalizations were eliminated last year alone, between $7 and $8 billion would be saved. Considering the tight financial picture for the state and the federal government, savings of that size must be pursued at all costs.

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