UPMC entered into the CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents in 2012. This four year initiative (Phase I) addressed the prevention of avoidable hospitalizations through the implementation of various clinical quality models.
The UPMC Community Provider Services ECCP (Enhanced Care and Coordination Provider), led by the Aging Institute of UPMC Senior Services and University of Pittsburgh, implemented five clinical interventions within 18 partner long-term care nursing facilities (LTCs) throughout Western Pennsylvania. These LTCs were located throughout rural, urban and suburban areas, and with varying status and ownership classifications including profit, not-for-profit, county, corporate, and locally owned.
Our ECCP implemented the clinical quality interventions to accomplish these five main objectives across Pennsylvania:
A 2014 RTI Evaluation showed our ECCP’s positive impact on potentially avoidable hospitalization (PAHs), all-cause hospitalization and ED visits.
While this clinical quality model did show success, Phase 1 of the initiative did not address the existing payment policies that may be leading to avoidable hospitalizations. The Medicare Payment Advisory Commission (MedPAC) reported in their June 2010 Report to Congress of the financial advantages of LTCs to transfer residents to a hospital.
CMS has launched a Phase II of this demonstration to test the effects of providing payment to skilled nursing facilities and practitioners for the treatment of specific conditions. Phase II has been designed to run until September 2020.
The three key components of Phase II include:
Fifteen of our partner facilities from Phase I will continue to receive the same clinical interventions received in Phase I PLUS participate in the Phase 2 payment model.
In addition, our EECP has partnered with another twenty (20) facilities across Pennsylvania to implement the payment model only.