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We Defend Healthcare Providers Nationwide in Audits & Investigations

The Current CMS Initiative on Reducing Hospital Admissions is Here!

The Current CMS Initiative on Reducing Hospital Admissions is Now Here.(April 23, 2012): According to the Director of the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office, more than 1800 entities have expressed interest in a CMS initiative that will provide $128 million over 4 years to entities to reduce hospital admissions and readmissions from nursing facilities for dual-eligibles (patients with both Medicare and Medicaid coverage). According to the CMS announcement, the Agency will partner with “enhanced care & coordination providers” to implement evidence-based interventions to reduce hospitalizations. Organizations eligible to apply for these grants include physician practices, care management organizations, and other public and not-for-profit entities.

The Center for Medicare & Medicaid Innovation (CMMI) Fact Sheet lists past demonstrations that have reduced avoidable hospitalizations through the use of nurse practitioners in nursing facilities to manage residents’ medical needs. Presumably, this refers to the EverCare demonstration project which was held several years ago. Additionally, the Fact Sheet discusses strategies such as implementing quality improvement and communication tools for changes in resident status and condition. Letters of intent are due to CMMI byApril 30, and proposals are due by June 14.

Private insurers also are expected to implement a variety of partnerships and strategies with nursing homes and other post-acute providers. For example, earlier this year Aetna announced an agreement with Genesis HealthCare, a large post-acute company, to establish an incentive arrangement if the company is able to reduce hospital readmissions.

We also anticipate a number of other types of innovative arrangements between nursing homes, insurers, and other providers and organizations, including managed care organizations, to develop strategies and incentives to provide more efficient care to post-acute patients, including managed care patients.

Michael CookMichael Cook recently presented to the American Health Lawyers Association Conference on Long Term Care and the Law on the topic of “Opportunities and Challenges to Managed Care Contracting for Post-Acute and Long Term Care Providers During and After Health Care Reform.” Providers and other entities desiring assistance in responding to incentives posited by the Affordable Care Act and CMMI should contact Michael Cook at (202) 298-8750. Michael has substantial experience in assisting post-acute providers and others in structuring innovative care delivery mechanisms to respond to the delivery systems reform incentives.