CMS applauds readmission reduction

In a January 17 blog, two Centers for Medicare and Medicaid Services (CMS) officials lauded that substantial progress has been made over the past year in reducing the number of hospitalizations of Medicare beneficiaries living in long-term care (LTC) facilities.

Indeed, the reduction in hospitalizations of Medicare fee-for-service beneficiaries is remarkable, down from 227 per 1,000 beneficiaries in 2010 to 157 in 2015. That’s a total of 352,000 hospitalizations in 2015. Of that, patients eligible for both Medicare and Medicaid benefits, dual eligible, accounted for 270,000 hospitalizations. According to CMS, almost a third of those were caused by six potentially avoidable conditions: bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, chronic obstructive pulmonary disease or asthma and skin ulcers.

“Through the concerted effort by CMS and many others to address these potentially avoidable conditions, real progress has been made to improve the health and well-being of some of our country’s most vulnerable citizens,” wrote Niall Brennan, director of the CMS Office of Enterprise Data and Analytics and CMS chief data officer, and Tim Engelhardt, director of the Federal Coordinated Health Care Office at CMS. They noted avoidable hospitalizations for LTC facility residents “can be dangerous, disruptive and disorienting.”

In addition to the 13 percent decline in the overall hospitalization rate for dual eligible beneficiaries, CMS officials said the hospitalization rate for beneficiaries with those six conditions living in LTC facilities dropped by 31 percent.

“Over the last several years, with the help from the Affordable Care Act, Medicare and Medicaid have worked with other federal agencies, states, patient organizations and others to identify and prevent those health conditions that have caused long-term care residents to be unnecessarily hospitalized,” Brennan and Engelhardt wrote.

They noted that in 2001 the Agency for Healthcare Research and Quality (AHRQ) drafted a set of measures to identify potentially avoidable hospitalizations. The CMS Office of Enterprise Data and Analytics recently found instances of those conditions were disproportionately high among dual eligible beneficiaries living in LTC facilities.

“Treating conditions before hospitalization and preventing these conditions whenever possible would not only help long-term care facility residents stay healthy, but may also save Medicare and Medicaid money,” they wrote. Thus, “CMS and others focused on reducing the instances of potentially avoidable hospitalizations from these facilities.”


Industry Initiative

Indeed, “others” did embark on the journey, namely, LTCfacility operators themselves, led by the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

“These results are consistent with our members’ efforts to reduce hospitalizations as part of our national Quality Initiative,” says David Gifford, MD, MPH, AHCA senior vice president of quality and regulatory affairs.

On average, AHCA members reduced rehospitalizations by nine percent. “Overall, 19.6 percent of AHCA/NCAL members have achieved an impressive 30 percent reduction in hospital readmissions,” Gifford says.

That translates into preventing more than 80,000 residents in members’ facilities from returning to the hospital, a significant savings to the healthcare system overall. “We are proud of this progress,” he says. “I’m confident that we will continue to see improvement.”

AHCA/NCAL’s Quality Initiative, which it has promoted heavily among members since its inception, focuses on improving organizational success, improving short-term/post-acute care and improving long-stay/dementia care. The latter objective is to be achieved by safely reducing off-label use of antipsychotics and safely reducing hospital readmissions.

The Initiative’s target was to safely reduce hospitalizations among long-stay residents by an additional 15 percent or achieve and maintain a low rate of 10 percent by March 2018. Gifford says many member companies are well on their way to achieving that goal—one that is fully aligned with the continued objectives of the federal government.

Robert Gatty has more than 40 years of experience in journalism, politics and business communications and is the founder and president of G-Net Strategic Communications based in Myrtle Beach, South Carolina. He can be reached at

Topics: Articles , Executive Leadership , Medicare/Medicaid , Regulatory Compliance