​Strategies to reduce hospitalizations were the focus of a pair of articles in the March 2017 issue of Health Affairs. The first article looked at the effectiveness of the Centers for Medicare and Medicaid Services' (CMS) initiative, launched in 2012, to examine the in reducing avoidable hospitalizations among nursing facility residents. The initiative examined the effects of using evidence-based clinical and educational interventions in 143 long-term facilities in seven states. State-specific analyses estimated that the initiatives resulted in a net reduction of 2.2 to 9.3 percentage points in the probability of all-cause hospitalization and 1.4 to 7.2 percentage points in the probability of avoidable hospitalization for residents, when compared with comparison groups. The results showed "promising evidence" that multipronged interventions to reduce admissions are working, the authors said. An increase in the presence of registered nurses had a particularly positive effect on reducing hospitalizations, the authors said. "Reducing such hospitalizations not only helps improve the quality of care and quality of life for nursing facility residents but also helps lower costs for Medicare and Medicaid," the authors said. The second article evaluated five CMS home-visit models and the impact they had on readmissions. Each model delivered home visits with services that complemented clinical primary or palliative care. The models differed in scale, size, and scope, ranging from implementation at a single site with fewer than 300 beneficiaries to those featuring multiple sites with more than 9,000 beneficiaries. But there were similarities—all five included care coordination and patient and consumer engagement; each model also offered an education component. In all, four of the five models were associated with a reduction in total Medicare expenditures or utilization when compared with those outcomes for matched comparison groups. All five models yielded multiple positive results regarding quality of care and four of the models demonstrated improved patient self-management. Although the similarities between the models demonstrated the value of having practice extenders provide home visits, the authors said, it is important to consider each model on its own terms.

HRC Recommends: Reducing avoidable hospitalizations in nursing home and home care settings is important not just because of CMS readmissions penalties. It is necessary to effectively manage residents' or clients' health in these settings and, whenever possible, proactively prevent and manage conditions before acute intervention is required. Reducing avoidable hospitalizations also reduces transitions of care, which may be disruptive, particularly for older adults and those with dementia, and may raise attendant risks, such as problems with handovers and communication across provider organizations. Hospitals can also play a role in reducing readmissions from these settings; efforts may include measures to ensure high-quality, evidence-based care throughout the patient's stay; comprehensive discharge planning and teaching; and effective coordination and communication with other healthcare providers.