UPMC has been awarded a $19 million grant from the Centers for Medicare and Medicaid Services (CMS) as part of a comprehensive initiative to improve the quality of care and reduce avoidable hospitalizations among nursing facility residents in western Pennsylvania.
UPMC Community Provider Services and its Aging Institute and Palliative and Supportive Care Institute, with partners Excela Health,Heritage Valley Health System, Jewish Healthcare Foundation and Robert Morris University, will collaborate over a four-year period on RAVEN, (Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents). The project aims to improve nursing facility resident outcomes; improve the transitions between hospitals and nursing facilities; and reduce overall health spending while ensuring access to care and choice of providers. UPMC and six other organizations have received RAVEN awards.
About two-thirds of nursing facility residents are enrolled in Medicaid, and most also are enrolled in Medicare, making this population among the most fragile and chronically ill served by these programs. CMS estimates that 45 percent of hospitalizations among Medicaid and Medicare enrollees receiving care at either Medicare skilled nursing facilities or Medicare nursing facilities are avoidable, which in 2011 alone would have saved an estimated $7 – 8 billion.
In western Pennsylvania, 16 nursing facilities have committed to making changes to improve care and reduce avoidable hospitalizations. Those changes include having nurse practitioners on-site who will work with existing nursing staff to provide preventive services, improve the assessment and management of residents’ medical conditions, and provide advance-care planning as well as support and treatment for those who choose palliative care as end-of-life approaches.
Other interventions include having nurse educators customize tools to help improve communication about residents’ changing medical conditions among nursing facility, staff, on-site nurse practitioners and physicians; training conducted by education partners about geriatric syndrome, palliative care and advance care planning; specialists improving management of residents’ prescription drugs to reduce the risk of pharmacy-related complications; and using telemedicine to enhance around-the-clock communications among facility nursing staff, physicians, acute care clinicians and nurse practitioners.
“We’re using a model that has proven to be successful,” said Katy Lanz, D.N.P., project co-director, UPMC. “Related interventions already in place within UPMC’s own nursing facilities have resulted in a 38 percent reduction of unplanned transfers from the facilities to acute care settings over a 26-month period, so we know these interventions will have a dramatic impact on resident outcomes, quality and cost.”
The seven organizations selected for RAVEN awards are Alabama Quality Assurance Foundation, Alegent Health, The Curators of the University of Missouri, Greater New York Hospital Foundation Inc., HealthInsight of Nevada, Indiana University and UPMC. All the groups will collaborate with the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act to improve health care quality and reduce costs in the Medicare and Medicaid programs.