Care coordination models show promise in reducing hospitalizations, Medicare costs among SNF residents

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Care coordination models tested through the Centers for Medicare & Medicaid Services' have indicated which strategies can help reduce hospitalizations, according to a new study.

The research, published Monday in Health Affairs, evaluated the seven Enhanced Care and Coordination Provider models tested as part of CMS' Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.

Those ECCPs, including Indiana's OPTIMISTIC program, all involved nurses, medication management, end-of-life planning and tools such as SBAR to help cut down on hospitalizations among long-stay residents.

The new evaluation, conducted by researchers at RTI International in Washington, D.C., estimated reductions between 2.2 and 9.3 percentage points in the likelihood of an all-cause hospitalization among residents participating in an ECCP model in 2015, and a drop of 1.4 to 7.2 percentage points in probability of a potentially avoidable hospitalization.

That same year average per-resident Medicare costs dropped between $60 and $2,248 for all-cause hospitalizations, and $98 to $577 for potentially avoidable hospitalizations.

Some models performed better than others, researchers found, specifically those that used registered nurses or nurse practitioners who provided consistent clinical care.

As CMS continues to push reducing avoidable rehospitalizations among nursing home residents, researchers said they will examine whether treating certain conditions at a facility can help. The goal is to help policymakers understand the “effectiveness, practicality, and challenges of implementing large scale clinical and educational interventions aimed at reducing potentially avoidable hospitalizations of long-stay residents of nursing facilities,” the study's authors concluded.