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CMS Launches Effort to Keep Nursing Facility Patients Out of Hospital

By John Reichard, CQ HealthBeat Editor

March 19, 2012 -- Nursing facility operators are under growing pressure from policymakers to prevent unnecessary hospitalizations of their residents.

Two developments last week pointed to those growing expectations.

The Centers for Medicare and Medicaid Services (CMS) announced a new program on March 15 under which doctors’ offices and other outside groups would work with nursing facilities to keep patients from having to make unnecessary trips to the hospital.

And the Medicare Payment Advisory Commission (MedPAC) released a report urging Congress to require Health and Human Services to reduce Medicare payments to skilled nursing facilities that transfer unusually large numbers of residents to the hospital.

CMS announced that it would award grants of up to $128 million to help keep the sickest Medicare patients—those who are also enrolled in Medicaid—out of the hospital once they are in nursing facilities.

The grants will fund organizations that keep patients on the right meds and get the right preventive care once they come out of the hospital and go into the nursing facility. Medications change as a result of a hospital stay, but communication between the hospital and the nursing facility is not always what it should be. CMS said doctor’s offices, care management organizations, and other public and not-for-profit entities are eligible for the grant money.

“Too often, nursing facility residents experience potentially avoidable inpatient hospitalizations,” a CMS fact sheet said. “These hospitalizations are expensive, disruptive and disorienting for frail elders and people with disabilities. Nursing facility residents are especially vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals, including medication errors and hospital-acquired infections.”

Each grant recipient must partner with at least 15 nursing facilities. Among other requirements, they must hire staff who maintain a physical presence at nursing facilities.

MedPAC’s March 15 report to Congress noted that if Medicare cut payments to providers that sent many patients back to the hospital, “skilled nursing facilities (SNFs) would have a financial incentive to furnish the care necessary to avoid rehospitalizations for conditions that are potentially avoidable, such as pneumonia and dehydration.” The report noted that the way things are now, “SNFs have an incentive to rehospitalize high-cost patients as a way to shift costs they would otherwise incur onto hospitals.”

John Reichard can be reached at [email protected].

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