- Starting this fall, CMS will test a new payment model aimed at reducing avoidable hospitalizations among nursing facility residents.
- Under this model, CMS would facilitate practitioner engagement when a patient requires more intense intervention due to an sudden or serious change in their condition.
- The four-year payment phase — set to kick off this fall — will be implemented through agreements with six Enhanced Care and Coordination Providers.
CMS funds ECCPs to test various models to improve care at skilled nursing facilities. Under the new model, practitioners would be reimbursed for engaging in multidisciplinary care planning activities, and the facility itself would receive payments for more aggressive treatment of common medical conditions that frequently end in hospitalization.
The model would also create payment parity for comprehensive assessments at skilled nursing facilities—bringing compensation in line with assessments performed at a hospital.
“This initiative has the potential to improve the care for the most frail, most vulnerable Medicare-Medicaid enrollees—long-stay residents of nursing facilities,” Tim Engelhardt, director of the Medicare-Medicaid Coordination Office, said in a statement.
The ECCP selected for the initiative are: Alabama Quality Assurance Foundation; HealthInsight Nevada, serving Nevada and Colorado; Indiana University; The Curators of the University of Missouri; The Greater New York Hospital Foundation; and UPMC Community Provider Services in Pennsylvania.
The new payment model is part of the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, a collaboration of the Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, which were created by the Affordable Care Act.