CMS last week announced that it had selected seven organizations to work with 145 nursing facilities to reduce avoidable hospitalizations, especially among patients who are joint Medicare and Medicaid beneficiaries. The chosen organizations include Alabama Quality Assurance Foundation, Alegent Health (Nebraska, the Curators of the University of Missouri, Greater New York Hospital Foundation, Inc., HealthInsight of Nevada, Indiana University, and UPMC Community Provider Services (Pennsylvania).
"All selected organizations will have on-site staff to partner with the existing nursing facility staff to provide preventive services as well as improve assessments and management of medical conditions," said the CMS announcement. "Participants will also work toward more seamless beneficiary transitions of care, and leverage use of emerging technologies, among many other activities."
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CMS' solicitation of proposals for the project stipulates that no grantee can spend more than 10% of its total award for health IT equipment and that the agency must approve the purchase of any IT-related gear that costs over $5,000. Moreover, the initiatives proposed by the grantees focus on having nurses and nurse practitioners improve the monitoring and care of patients within the long-term-care facilities.
Nevertheless, the CMS official said, the grantees proposed different ways of improving communications with hospitals and physicians, as well. These include linking nursing homes to health information exchanges (HIEs) and customizing their existing electronic health records to facilitate data exchange with hospitals.
Currently, there is little exchange of electronic data between acute-care hospitals and post-acute-facilities, even though nursing home residents often bounce back and forth between these two settings of care. Many nursing homes have EHRs that they use to supply required clinical data to CMS, but most of those systems are not made by the same vendors that supply hospital and ambulatory-care EHRs.
In addition, few long-term-care facilities are linked to HIEs. To connect them to the exchanges would require the building of interfaces that don't exist today.
Nursing home EHRs also are not designed to generate clinical summaries known as continuity of care documents (CCDs), which are used to exchange data between disparate EHRs in other care settings. Recently, the Keystone Beacon Community, led by the Geisinger Health System, pioneered the use of Caradigm software that converts the data sets that nursing facilities report to CMS into CCDs. That allows the facilities to send data to the Keystone HIE. But it might take a while for such an approach to become widespread in post-acute care.
In the meantime, according to CMS, one grantee has proposed deploying remote monitoring technology in nursing homes. The organization would provide the long-term-care facilities with a telehealth cart equipped with digital stethoscopes, blood pressure monitors, and other vital sign monitors, along with a video camera. The telecommunications setup would allow a physician outside the facility to view a resident's vital signs and perform a visual examination on a high-definition screen.
This kind of technology has a lot of potential, because it is often difficult for a patient's physician to visit the nursing home when the patient is showing signs of distress and spend the time necessary to prevent an avoidable hospitalization, the CMS official noted.
CMS hopes that if the demonstration project shows the effectiveness of certain innovations in post-acute care, accountable care organizations and other new care delivery systems can make use of them. In addition, CMS could also expand their use in the care delivered to Medicare patients. Under the Affordable Care Act, which authorized the demonstration, if any of the new methods cut costs and improve outcomes, the Secretary of Health and Human Services can extend them to other Medicare beneficiaries before the end of the four-year program.
Today, it is estimated that 45% of the readmissions of Medicare and Medicaid patients receiving care in nursing homes could be avoided. Total costs for these potentially avoidable hospitalizations for Medicare-Medicaid enrollees for 2011 were estimated to be between $7 billion and $8 billion.
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