CMS’ final evaluation report of phase one of their Initiative to Reduce Avoidable Hospitalizations among Nursing Facility (NF) Residents found that intervention sites with a full-time nurse at each facility providing direct care to residents had the strongest improvements in both cost and quality. These models demonstrated greater changes in facility culture, greater support for the need to reduce avoidable hospitalizations, and greater overall buy-in to the Initiative from facility staff, resulting in stronger intervention effects. Intervention sites where nurses did not provide direct care, or where nurses rotated across multiple facilities, showed less consistent effects.
The Initiative was designed to affect hospitalization rates among long-stay nursing facility residents by directly changing practices at the facility level. The Initiative was implemented from 2013–2016 by seven Enhanced Care and Coordination Provider (ECCP) organizations, selected by CMS from solicited applications. Each ECCP operated in one of seven states (Alabama, Indiana, Missouri, Nebraska, Nevada, New York, and Pennsylvania), and a total of 143 nursing facilities participated, each partnering with one ECCP.
All seven sites involved in the initiative were able to reduce hospitalizations, with six of the seven achieving statistically significant improvement in either all-cause hospitalizations, potentially avoidable hospitalizations, or both.
According to the report, “Overall, these findings provide persuasive evidence of the Initiative’s effectiveness in reducing hospital inpatient admissions, ED visits, and hospitalization-related Medicare expenditures.”