A federal partnership with seven health systems is testing whether a new payment model that supports telemedicine can be used to reduce hospitalizations of long-term residents in nursing homes.
The Centers for Medicare and Medicaid Services is launching the second phase of this three-year project, which tests whether "high-intensity treatment services" can reduce avoidable hospitalizations, lower Medicare and Medicaid spending and improve the residents' quality of care.
The project seeks to prove that this method would be as effective in treating the residents as an on-site clinic, and includes Medicare payments to clinicians "at a level similar to the payments they would receive for treating beneficiaries in a hospital," as well as new payments for taking part in care planning activities.
The organizations involved in the project are UPMC Community Provider Services in Pennsylvania, the Alabama Quality Assurance Foundation, The Greater New York Hospital Foundation, Nebraska's Alegent Health, the Curators of the University of Missouri, HealthInsight of Nevada and Indiana University.
According to CMS, roughly 45 percent of hospital admissions involving Medicare or Medicaid enrollees in long-term nursing facilities could have been avoided, amounting to roughly $2.6 billion in Medicare expenditures in 2005.
CMS reported "promising initial results" during the first phase of the project, with five of the participants (called "enhanced care and coordination providers," or ECCPs) showing "some degree of reduction in hospitalization levels."
Each ECCP is approaching the project differently. UPMC, for example, is using telehealth in its RAVEN (Reduce Avoidable hospitalizations using Evidence-based interventions in Nursing facilities in western Pennsylvania) program, which connects participating nursing facilities to the Western PA Health Information Exchange. Other programs place clinicians at the facility to coordinate care management and communicate with appropriate healthcare providers when the need arises, while the Greater New York Hospital Foundation is creating an electronic system to give providers quick access to beneficiary information.
The project is scheduled to run from October 2016 to October 2020.