Skilled Nursing Facilities Cut Hospitalizations in CMS Initiative

A multi-year initiative from the Centers for Medicare & Medicaid Services (CMS) to lower hospitalizations in long-term care has its first set of finalized results, with data showing that the plan is working so far.

CMS on Friday announced that all seven participating sites saw declines in hospitalizations. Six of the seven had statistically significant drops in either all-cause or potentially avoidable hospitalizations, according to the government agency.

“Overall, these findings provide persuasive evidence of the initiative’s effectiveness in reducing hospital inpatient admissions, ED visits, and hospitalization-related Medicare expenditures,” the report authors wrote.


Under the Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents, 143 nursing homes in seven states — Alabama, Indiana, Missouri, Nebraska, Nevada, New York and Pennsylvania — partnered with enhanced care and coordination providers (ECCPs). These groups worked directly with the skilled nursing facilities in their respective states, providing either registered nurses (RNs) or advanced practice registered nurses (APRNs) to offer on-site training and supervisory services.

In some cases, the nurses also performed direct clinical care, and all participating ECCPs helped implement a variety of new practices at the facilities — including end-of-life care, medication management, and Interventions to Reduce Acute Care Transfers (INTERACT) training.

The first phase of the program began in 2014 and wrapped up in 2016, with CMS this week releasing the first set of finalized data from the study.


Across all seven states, the facilities saw a relative reduction in potentially avoidable hospitalizations of 17.0%, and a relative dip of 9.5% in all-cause hospitalizations. In addition, CMS found reductions in Medicare spending in six out of the seven states, though that number dropped to four when accounting for grants given to the ECCPs.

“Interview data suggest there has been a generally positive reception to the initiative across ECCPs, with facility staff and leadership expressing interest in sustaining many initiative components as permanent facility functions,” the study authors wrote.

States in which the supplemental nursing staff performed hands-on care tended to have better outcomes, CMS observed, with the education-only sites seeing less consistent improvements in hospitalization and spending levels.

Participating facilities didn’t receive any compensation as part of the first phase, but under the next phase, SNFs will receive payments for treating certain conditions in house instead of discharging patients to other facilities; CMS plans to study the effect of these cash incentives in the second round of analysis.

Written by Alex Spanko

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