Medicare-Medicaid’s initiative to reduce avoidable hospital stays for nursing home residents looks promising

RESEARCH TRIANGLE PARK, NC — An initiative aimed at preventing unnecessary hospital stays shows promise for protecting frail, elderly patients from health risks while saving money for Medicare, according to a new study by researchers at RTI International.

In the study, published in the March issue of the journal Health Affairs, a team from RTI examined a program launched in late 2012 by the Centers for Medicare and Medicaid Services. The program involved sending highly trained nurses into nursing facilities to introduce clinical and educational practices that help keep residents from being sent to the hospital unnecessarily. Facilities in Alabama, Indiana, Missouri, Nebraska, Nevada, New York, and Pennsylvania participated.

The researchers found that, in 2015, the initiative reduced the chance of all hospitalizations by between 2.2 and 9.3 percentage points, depending on the state, and the chance of potentially avoidable hospitalizations by 1.4 to 7.2 percentage points.

At one of the sites, 2015 Medicare hospital payments were reduced by $2,248 per resident per year. These were reductions relative to similar residents from comparison facilities not participating in the initiative.

Improving practices in nursing homes does require time and resources, but it can be effective, said Melvin Ingber, Ph.D., a health services researcher at RTI and first author of the study.

“The degree of success varied by level of buy-in by facility and corporate leadership, buy-in by physicians, rate of turnover of staff, and intensity of clinical interventions. Even personalities mattered,” Ingber said. “The effects were strongest when advanced practice nurses provided hands-on clinical care in addition to training or education for facility staff.”

The study grew out of a federal effort to cut down on hospital stays among long-term residents of nursing facilities. More than 25 percent of these patients are hospitalized each year, and research indicates that as many as 47 percent of these hospital stays may have been avoidable. According to one study, Medicare and Medicaid spent $1.9 billion in 2005 on hospital stays that could have been avoided.

The program involved having RNs and nurse practitioners provide extra support, ranging from training in the use of INTERACT tools to improve communication between providers to direct patient care and end-of-life counseling. Depending on the states’ regulations, in some states nurse practitioners were able to provide clinical care, including assessing and treating residents and prescribing medications or lab tests.

The effects were stronger when nurses provided hands-on clinical care instead of just training or education for facility staff.

After going through the initiative, many of the facilities experienced a cultural shift, said Galina Khatutsky, an RTI public health researcher and co-author of the study.

“In the facilities with strong leadership support and committed staff, we have observed some real shifts in attitudes, in facility culture, particularly in the way hospitalizations are considered,” Khatutsky said. “The default is no longer to send residents out with every emergency.”