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New Initiative Seeks to Reduce Hospitalizations for Dually Eligible Patients

By Rebecca Adams, CQ HealthBeat Associate Editor

September 27, 2012 -- Federal officials announced last week that seven nursing facilities will receive grants to enable them to test models to reduce avoidable hospitalizations, which cost Medicare and Medicaid $7 billion to $8 billion in 2011.

About 45 percent of hospital admissions for Medicare and Medicaid patients receiving care in nursing facilities could be prevented, Centers for Medicare and Medicaid Services (CMS) officials say. Avoidable hospitalization is one of many factors that drives up the cost of care for patients and, in particular, leads to high spending on dually eligible beneficiaries.

The seven organizations involving over 140 facilities will add on-site staff to help the current nursing staff provide preventive services and better monitor patients' medical conditions. The facilities will try to provide more seamless care in order to avoid problems that emerge when patients are moved between a hospital and nursing facility, and they will use more technology to oversee patients. The facilities also agreed to put in place systems that will better monitor the patients' use of prescription drugs, including psychotropic drugs.

The initiative is one of the experiments supported by the CMS Innovation Center and the CMS Medicare-Medicaid Coordination Office, both of which were created by the 2010 health care law (PL 111-148, PL 111-152). The CMS Medicare-Medicaid Coordination Office, has been involved in a number of initiatives aimed at trying to improve the way that the two programs work together.

"We are excited about this partnership and the programs these seven organizations are putting in place to work with nursing facilities to ensure the best possible care for their residents." CMS Acting Administrator Marilyn Tavenner said in a written statement. "We view this initiative and the enhanced level of collaboration it will generate among a variety of providers as the key to reducing costly and avoidable hospitalizations for this population that often has the most complex health care needs."

The recipients were in Alabama, Indiana, Missouri, Nebraska, New York, Nevada, and Pennsylvania.

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