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Avoidable Admissions for Long-Term Care Dual Eligibles Down 31%

Preventable hospital admissions for dually-eligible long-term care residents have plummeted thanks to investments in patient safety and value-based care.

Avoidable admissions for long-term care residents

Source: Thinkstock

- Avoidable hospital admissions for long-term care residents eligible for both Medicare and Medicaid have dropped by 31 percent over the past five years thanks to improvements in patient safety and the adoption of population health management techniques.

In a new data brief, CMS officials note that a concerted, multi-stakeholder effort to address preventable admissions and readmissions in the long-term care environment has produced “dramatic” gains for Medicare and Medicaid beneficiaries.

“For long-term care facility residents, avoidable hospitalizations can be dangerous, disruptive, and disorienting. Keeping our most vulnerable citizens healthy when they are residents of long-term care facilities and reducing potentially avoidable hospital stays has been a point of emphasis for CMS,” said Niall Brennan, Chief Data Officer and Director of the CMS Office of Enterprise Data and Analytics, alongside Tim Engelhardt, Director of the Federal Coordinated Health Care Office.

“Over the last several years, with the help from the Affordable Care Act, Medicare and Medicaid have worked with other federal government agencies, states, patient organizations, and others to identify and prevent those health conditions that have caused long-term care residents to be unnecessarily hospitalized.  Because of these efforts, we have seen a dramatic reduction in avoidable hospitalizations over the last several years.”

Potentially avoidable hospitalization (PAHs) have been disproportionately high among dually eligible patients living in long-term care, Brennan and Engelhardt added.  Preventable or manageable conditions including bacterial pneumonia, urinary tract infections, dehydration, COPD, and congestive heart failure are often responsible for bringing LTC residents into the hospital, an expensive and unpleasant event for most patients.

Percent change in LTC avoidable admissions

Source: CMS

A focus on improving care quality and preventive measures in the LTC environment over the past five years has resulted in a 19 percent drop in the number of hospitalizations for LTC dual eligibles due to any reason, and an even more dramatic decline specifically for hospitalizations related to preventable events.

“In 2010, the rate of potentially avoidable hospitalizations for dually-eligible beneficiaries in long term care facilities was 227 per 1,000 beneficiaries; by 2015 the rate had decreased to 157 per 1,000,” said Brennan and Engelhardt.

“This decrease in potentially avoidable hospitalizations happened nationwide, with improvement in all 50 states. The reduced rate of potentially avoidable hospitalizations means that dually-eligible long-term care facility residents avoided 133,000 hospitalizations over the past five years.”

State by state reductions in preventable hospitalizations

Source: CMS

CMS has seen similar improvements in the 30-day readmissions rate among its general Medicare population.  In September of 2016, the agency announced that forty-three states had seen 30-day readmission rates drop by more than 5 percent since 2010, due to the influence of patient safety education initiatives, penalty programs, and value-based care strategies.

The AHRQ Safety Program for Long-Term Care, Hospital Readmission Reduction Program, and a 2011 pilot program to reduce avoidable hospitalizations among nursing facility residents have all contributed to the development of best practices and preventive care techniques related to reducing the readmissions rate.

“This success shows that a sustained commitment to smarter spending across the entire health care system can yield dramatic results and improve the lives of vulnerable Americans,” said Englehardt and Brennan. “These results are also consistent with other ongoing collaborative efforts to improve the quality of care patients received through preventing hospital-acquired conditions where approximately 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in health care costs were saved from 2010 through 2015.”

“Finding the best possible long-term care facility care for a loved one is one of the most difficult decisions family members can make. Family members want to be assured that their loved one will receive the highest quality of care in a healthy environment. And thanks to efforts across the health care industry, and with tools from the Affordable Care Act that allow CMS to improve quality and test innovative strategies, these residents are living in safer, healthier environments.”

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