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Improving IV Insulin Administration in a Community Hospital

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CMS Initiative to Reduce Potentially Avoidable Hospitalizations Among Long-Stay Nursing Facility Residents: Lessons

Denise A Tyler¹, Zhanlian Feng¹, David C Grabowski²

¹RTI International.

The Milbank Quarterly

|December 27, 2022

Summary

This summary is machine-generated.

Providing clinical staff in nursing homes effectively reduced hospitalizations, unlike Medicare payment incentives alone. Adequate staffing is crucial for reducing avoidable resident hospitalizations.

Keywords:

Medicaid Medicare hospitalizations long-term care nurse practitioners nursing homes

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Area of Science:

Healthcare Management
Gerontology
Public Health Policy

Background:

Medicare and Medicaid incentives may lead to avoidable hospitalizations in long-stay nursing home residents.
The Centers for Medicare and Medicaid Services (CMS) launched an initiative to reduce these hospitalizations.

Purpose of the Study:

To evaluate the effectiveness of clinical interventions and Medicare payment incentives in reducing nursing home hospitalizations.
To identify implementation facilitators and barriers for participating nursing homes.

Main Methods:

Mixed-methods approach including interviews and difference-in-differences regression analysis.
Compared utilization, expenditures, and quality in participating versus nonparticipating nursing homes.

Main Results:

Clinical-Only interventions in Phase 1 successfully reduced hospitalizations.
Clinical + Payment and Payment-Only interventions did not show evidence of reducing hospitalizations.
Staff retention, leadership support, and provider engagement were key to successful implementation.

Conclusions:

Clinical staff availability and support are essential for reducing nursing home hospitalizations.
Medicare payment incentives alone were insufficient to decrease hospitalizations.
Adequate nursing home staffing is necessary for further reductions in avoidable hospitalizations.