UPMC Program Achieves Reduced Hospitalizations and Costs in Area Nursing Facilities in CMS Initiative
PITTSBURGH, March 2, 2016
– A report commissioned by Centers for Medicare and Medicaid Services
(CMS) finds that UPMC and its community partners are achieving significant reductions in avoidable hospitalizations and costs in the third year of a comprehensive initiative to improve care in skilled nursing facilities across western Pennsylvania.
Nearly two-thirds of nursing facility residents are enrolled in Medicaid, and most also are enrolled in Medicare, making this population among the most fragile and chronically ill served by these programs. CMS estimates that as many as 45 percent of hospitalizations could be avoided among Medicaid and Medicare enrollees receiving care at Medicare-regulated skilled nursing facilities.
In 2012, UPMC was one of seven organizations awarded a grant from CMS to reduce potentially avoidable hospitalizations. While all sites showed a general reduction in Medicare expenditures, the year-three evaluation report found the UPMC program, called RAVEN (Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents), was one of two programs that significantly reduced avoidable hospitalizations and costs.
In western Pennsylvania, potentially avoidable hospitalizations were reduced nearly 25 percent, while potentially avoidable emergency department visits were reduced more than 40 percent. The reduction in health care utilization led to a net savings to CMS of more than $5 million.
“These exciting early results show the interventions being implemented are having a positive impact on resident care, quality and cost,” said April Kane, UPMC’s RAVEN Project co-director.
In western Pennsylvania, 18 nursing facilities have committed to making changes to improve care and reduce potentially avoidable hospitalizations. Those changes include on-site enhanced care staff, specifically nurse practitioners and enhanced registered nurses, who work with facility nursing staff to provide preventive services, improve the assessment and management of residents’ medical conditions, and provide advance-care planning, support and treatment for those who choose palliative care as end of life approaches.
Other interventions include educating clinical staff about customized tools to help improve communication about residents’ changing medical conditions; expert training about special health needs of the elderly, palliative care and advance-care planning; improved management of residents’ prescription drugs to reduce the risk of medication-related complications; and telemedicine to manage any worsening of a medical condition experienced by a resident after hours.
UPMC has applied for a subsequent round of CMS funding to launch RAVEN’s second phase. If funded, RAVEN will explore whether a new payment model for nursing facilities and practitioners will improve quality of care by further reducing potentially avoidable hospitalizations, while lowering combined Medicare and Medicaid spending.
The seven organizations involved in this CMS Innovation project are Alabama Quality Assurance Foundation, Alegent Health, The Curators of the University of Missouri, Greater New York Hospital Foundation Inc., HealthInsight of Nevada, Indiana University and UPMC. All the groups collaborate with the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve health care quality and reduce costs in the Medicare and Medicaid programs. More information about this program can be found on the CMS website: https://innovation.cms.gov/initiatives/rahnfr/