CMS Releases Phase Two of Initiative to Reduce Avoidable Hospitalization Among Nursing Facility Residents

Since September 2012, under Phase One of theInitiative to Reduce Avoidable Hospitalization Among Nursing Facility Residents, CMS has partnered with seven Enhanced Care and Coordinator Providers (ECCP) organizations in seven states, as an effort to improve care for nursing facility’s long-term residents. Indiana is one of those seven states included in this initiative. In conjunction with Phase One, Indiana University created OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality, and Improving Symptoms: Transforming Institutional Care), which includes the deployment of Registered Nurses (RNs) and Advanced Practice Nurses (APNs) to be on-site at nursing facilities, allowing for enhanced recognition and management of acute changes in medical conditions. IHCA has learned that OPTIMISTIC is currently evaluating Phase Two of the initiative. To read about Phase One, click here.

On August 27, 2015 CMS release Phase Two, which includes the four-year funding opportunity that will be implemented in current ECCP facilities and newly recruited facilities. The payment model incentivizes nursing facilities to expand internal resources to treat and/or manage residents in six defined acute conditions (Pneumonia, Dehydration, Congestive Heart Failure (CHF), Urinary Tract Infection (UTI), Skin Ulcers/Cellulitis, and COPD/Asthma). This would allow facilities to treat residents on site, rather than sending them to a hospital.

Successful ECCP applicants will implement the new payment model with both their existing facilities and newly recruited facilities in October 2016. This payment structure is intended to allow CMS to continue to 1) Identify the impact of the clinical interventions, 2) evaluate the impact of a new payment model, and 3) Assess the impact of both these models combined. Relative dates and time for application process are below.

· Notice of Intent to Apply: September 9, 2015
· Electronic Application Due Date: October 29, 2015, by 5:00 p.m. Eastern Time
· Anticipated Notice of Award: January 15, 2016
· Anticipated Project Period of Performance: January 15, 2016 to October 23, 2020

To read about Phase Two, click here.