AQAF is one of only seven organizations in the nation to implement the “Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.” The initiative will test models to improve quality of care and help reduce avoidable hospitalizations among nursing facility residents by funding organizations that provide enhanced on-site services and support to nursing facility residents. The initiative is run collaboratively by the Centers for Medicare & Medicaid Services (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.
Almost two-thirds of nursing home residents are enrolled in Medicaid and most are also enrolled in Medicare. Research found that approximately 45 percent of hospitalizations among this population could have been avoided, meaning they could have been prevented or treated in a lower intensity setting. Total costs for these potentially avoidable hospitalizations in 2011 were estimated to be between seven and eight billion dollars. In addition, avoidable hospital admissions create unnecessary stress on the patient and family and increase the chance of adverse errors when a patient is transferred from one provider to another.
AQAF is the lead organization in Alabama and is working with 23 nursing homes in 14 counties in central and north central Alabama. Partnering with AQAF on the initiative are the Alabama Department of Senior Services, the Alabama Department of Public Health, the Alabama Medicaid Agency, the University of Alabama Center for Mental Health and Aging, the University of Alabama at Birmingham’s Department of Gerontology and Palliative Medicine, Samford University’s McWhorter School of Pharmacy, the Alabama Nursing Home Association, the Alabama Hospital Association, and the Alabama Medical Directors Association.
“This initiative and the collaboration of these groups are critical to the reduction of costly and avoidable hospitalizations for nursing home residents who have complex health care needs,” says Liz Prosch, Vice President of Quality for AQAF and the project manager for this initiative. “We are in the readiness phase, pulling together operating systems and protocols. Our target implementation date is February 1, 2013.”
The goal for the Alabama initiative is expected to:
- Have a more than 50 percent impact on reducing potentially avoidable hospitalizations over a four-year period,
- Improve beneficiary health outcomes,
- Provide better transition of care for beneficiaries between inpatient hospitals and nursing facilities, and
- Promote better care at lower costs while preserving access to beneficiary care and providers.
To achieve these goals, the AQAF team will deploy registered nurses in the 23 partnering facilities in Alabama to implement a resident risk assessment program and a training program to help nursing facility staff enhance skills for managing workplace demands and professional relationships. “Once we recruit and place the nurses, we will deploy an intervention that is designed to help improve systems and processes that will help them gain skills and competencies needed to manage conditions and to detect changes in patients’ conditions earlier,” Prosch says. “We will work with certified nursing assistants and RNs to stabilize nursing home staffs and reduce turnover. That will help develop consistency in staffs so nurses will know the patients better and will be more able to recognize changes in a patient’s condition. It also will give nurses more confidence when treating patients.”
AQAF Chief Executive Officer Wes Smith, MD says that recent research indicates that the annual turnover rate among front line staff at nursing homes can be as high as 75 percent. “It is difficult to provide appropriate, patient-centered care under those circumstances. Part of our work will involve preparing the nurses and nurses’ assistants for some of the difficulties of the job,” he says. “We stand a better chance of making significant quality improvements with a prepared and stable work force. The nursing homes should also be able to realize some cost savings by decreasing their turnover rates.”
Prosch says they also want to improve resident and family engagement with the nursing staffs. “We want to teach residents and family members how to communicate better with physicians and staff,” she says. “We also want to educate residents on self-care in managing their chronic diseases, giving them more responsibility for their own care when possible. This will help each facility create and develop a culture where residents and family members will have a voice in the decision-making process.”
An advisory council made up of a family member and a facility representative from each nursing home will give feedback on the effort and will help evaluate the outcome, Prosch says. She emphasizes that this initiative would not be possible without the leadership of the 23 nursing homes.
“The staffs of these facilities have made a commitment to quality. With their help, we will develop a process that is hardwired in organizational skills, knowledge and competency,” Prosch says. “That will help nursing teams do a good job of managing changes in acute conditions and chronic illnesses.”