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Reducing Avoidable Hospitalizations Among Nursing Facility Residents

October 12, 2012

By Glenda Motta RN, MPH

The Center for Medicare & Medicaid Services (CMS) reports that nearly one in five Medicare patients discharged from a hospital—approximately 2.6 million seniors—is readmitted within 30 days, at a cost of over $26 billion every year.

The Community-based Care Transitions Program (CCTP), created by Section 3026 of the Affordable Care Act, is working to improve beneficiary transition from the inpatient hospital setting to other care settings, improve quality of care, reduce readmissions for high risk beneficiaries, and document measurable savings to the Medicare program.

Medicare-Medicaid enrollees (the majority of long-term nursing facility residents) are among the most fragile and chronically ill individuals. CMS reports that approximately 45 percent of hospitalizations among these enrollees receiving Medicare skilled nursing facility (SNF) services or Medicaid nursing facility care could have been avoided. Total costs for these potentially avoidable hospitalizations for 2011 were estimated to be between $7 and 8 billion.

CMS recently announced that it will partner with seven organizations to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The organizations (referred to as “enhanced care & coordination providers”) will implement evidence-based interventions aimed at reducing avoidable hospitalizations.

For years, improving quality of care in nursing facilities has been touted as a major goal. In fact, I first worked on two quality improvement initiatives funded by HCFA (prior to CMS) in 1981 following graduate school. The result ultimately became the surveyor guidelines and MDS documentation familiar to anyone in long-term care.

While no doubt the quality of care has improved in many facilities, too often administration fails to see the value in preventive services (such as a program to help ensure preservation of skin integrity) or purchasing high quality mattresses that provide better pressure redistribution, control of moisture, and patient envelopment. Failing to invest in prevention, coupled with staff shortages, poor English language skills, and insufficient ongoing caregiver education often impacts outcomes of care.

So, will we see evidence-based interventions for the prevention of pressure ulcers, incontinence-associated dermatitis, wound infections, medication errors (and the list goes on) become the norm in every facility? How will this quality initiative be different? What will be the impact on wound care practice?

Will wound care clinicians and other clinical experts become involved with these organizations? If so, what role will they play? Let us hear your thoughts and experiences as the initiative moves forward.

About The Author
Glenda Motta RN, MPH is a reimbursement consultant and wound care expert, publishing over 125 articles and books, serving as the President of the WOCN (1987-1989), and founding GM Associates, Inc., a healthcare marketing and reimbursement firm.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.