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​UPMC to Implement New Payment Model for Nursing Homes to Continue Care Improvements

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PITTSBURGH, Oct. 17, 2016 – In an effort to continue improving care at the region’s nursing homes, UPMC this month will start participating in a new model that dramatically changes the way that these facilities are paid. This change builds upon UPMC’s success in reducing avoidable hospitalizations in skilled nursing facilities across western Pennsylvania since 2012.
Implementation of this second phase of the so-called RAVEN (Reduce Avoidable Hospitalizations using Evidence-based Interventions for Nursing Facilities in western Pennsylvania) Project is supported by a $20 million grant to UPMC from the Centers for Medicare and Medicaid Services (CMS).  
A recent report commissioned by CMS found that UPMC and its community partners in the third year of the RAVEN Project reduced avoidable hospitalizations nearly 25 percent and potentially avoidable emergency department visits by more than 40 percent. The reduction in health care utilization led to a net savings to CMS of more than $5 million.
Phase two of the RAVEN initiative will apply the new payment model and other proven care interventions at the current RAVEN partner facilities, while implementing only the payment changes at 20 additional skilled nursing facilities in the state that are joining RAVEN. The initiative will be conducted over a four-year period to determine if this innovative reimbursement model for nursing facilities and practitioners significantly improves the quality of care compared to nursing facilities without this model.
The new approach will provide payments to practitioners for engaging in multidisciplinary care-planning activities; reimburse participating skilled nursing facilities if they provide treatment in-house for common medical conditions that frequently lead to avoidable hospitalizations; and pay physicians the same rate for treating patients at a skilled nursing facility compared to an assessment at a hospital.
“This is a very exciting opportunity to lead changes in CMS payment practices and to have a meaningful effect on nursing facilities and residents,” said April Kane, UPMC’s RAVEN Project co-director. “We have partnered with 20 additional facilities in Pennsylvania to have an impact on care, quality and cost.”
Phase-one care interventions included 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 use of telemedicine to manage worsening of a medical condition experienced by a resident after hours.
In addition to UPMC, other organizations involved in phase two of the CMS Innovation project are Alabama Quality Assurance Foundation, The Curators of the University of Missouri, HealthInsight of Nevada, Indiana University, and The Greater New York Hospital Foundation, Inc. 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.