Reducing Transfers among Long-Stay Nursing Facility Residents to Acute Care Settings: Effect of the 2013‒2016 Centers for Medicare and Medicaid Services Initiative.

OBJECTIVES: From 2013 to 2016, the Centers for Medicare and Medicaid Services Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents ("the Initiative") tested a series of clinical interventions and care models, through organizations called Enhanced Care and Coordination Providers (ECCPs), with the goal of reducing avoidable inpatient hospital admissions among long-stay nursing home residents. We identify the effect of the Initiative on the probability and count of acute care transfers [capturing any transfer to the hospital, including hospitalizations (inpatient stays), emergency department visits, and observation stays]. DESIGN: We evaluate the effect of the Initiative on the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers and estimate the average effect of the Initiative per resident per year. SETTING AND PARTICIPANTS: We use 2011-2016 data from the Centers for Medicare and Medicaid Services Minimum Data Set, version 3.0, nursing home resident assessments linked with Medicare eligibility and enrollment data and Medicare inpatient and outpatient hospital claims. Our sample is limited to Medicare fee-for-service beneficiaries in participating ECCP facilities and a comparison group of long-stay nursing facility residents. METHODS: We evaluate the effect of the Initiative on both the probability and count of all-cause acute care transfers and potentially avoidable acute care transfers using difference-in-differences regression models controlling for both resident-level clinical and demographic characteristics as well as facility-level characteristics. RESULTS: We found statistically significant evidence of a reduction in both the probability and count of all-cause and potentially avoidable acute care transfers among long-stay nursing facility residents who participated in the Initiative, relative to comparison group residents. CONCLUSIONS AND IMPLICATIONS: The clinical interventions and care models implemented by the ECCPs show that by using staff education, facility leadership and physician engagement, and/or clinical assessment and treatment of residents who experienced a change in condition, it is possible to reduce acute care transfers of nursing facility residents. This could lead to better outcomes and reduced cost of care for this vulnerable patient population.