New CMS Payment Model Aims to Advance Nursing Facility Care
By - The Centers for Medicare & Medicaid Services (CMS) recently announced an innovative funding opportunity to allow payment model testing within nursing care facilities. Originated to advance the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, participating organizations under this funding opportunity can request to apply and test payment models. CMS confirms the objective of such is to help decrease avoidable hospitalizations, lessen combined Medicare and Medicaid spending, and advance care quality among nursing facility residents.
“The intent of the new payment model is to reduce avoidable hospitalizations by funding higher-intensity interventions in nursing facilities for residents who may otherwise be hospitalized upon an acute change in condition. Improving the capacity of nursing facilities to treat medical conditions as effectively as possible within the facility has the potential to improve the residents’ care experience at lower cost than a hospital admission,” CMS states. “The model also includes payments to practitioners (i.e., physicians, nurse practitioners and physician assistants) similar to the payments they would receive for treating beneficiaries in a hospital. Practitioners would also receive new payments for engagement in multidisciplinary care planning activities.”
CMS has collaborated with 7 Enhanced Care and Coordination Providers (ECCPs) over the course of the past three years to test a model intended to improve care received by long-stay nursing facility residents. ECCPs cooperate with 144 nursing facilities among seven states — Alabama, Indiana, Missouri, Nebraska, New York, Nevada, and Pennsylvania — to deliver on-site training staff, provide preventive services, and improve medical conditions’ managing and operational details.
“This Initiative has the potential to improve the care for the most frail, most vulnerable Medicare-Medicaid enrollees — long term residents of nursing facilities,” states Tim Engelhardt, Director of the Medicare Medicaid Coordination Office. “By aligning financial incentives, we can improve the quality of on-site care in nursing facilities and the assessment and management of conditions that too often now lead to unnecessary and costly hospitalizations,” he adds.
According to CMS, a four-year payment phase will begin in October of 2016. There will be a “rigorous external evaluation” to verify cost and care quality impact. “Successful ECCP applicants would implement the payment model with both their existing partner facilities, where they provide training and clinical interventions, and in a comparable number of newly recruited facilities,” CMS explains. Awarded interventions within the initiative's primary phase have reached nearly 16,000 beneficiaries per month, CMS adds.
The transition from volume to value, nonetheless, pushes onwards. As RevCycleIntelligence.com reported, skilled nursing facility payments are expected to rise by $500 million. Total annual spending for the care of Medicare-Medicaid enrollees – the most chronically ill and complex enrollees among both programs – nears $300 billion. Almost half of hospitalizations among this population are essentially avoidable, says CMS. Nonetheless, CMS confirms its initiative serves as part of the organization’s administrative mission to improve healthcare quality, reduce Medicare and Medicaid costs, improve long-term care facilities, and connect skilled nursing facility payment to quality measure reporting.
