Avoidable Hospitalizations among LTC Residents Drops by 31 Percent

A data brief from the Centers for Medicare & Medicaid Services (CMS) has revealed that avoidable hospitalizations among long-term care facility residents has dropped by about 31 percent since 2010.

The brief—written by Niall Brennan, director of the CMS Office of Enterprise Data and Analytics, and CMS chief data officer; and, Tim Engelhardt, Director of the Federal Coordinated Health Care Office at CMS—noted that in 2015, Medicare fee-for-service (FFS) beneficiaries living in long-term care facilities had a total of 352,000 hospitalizations. Of this number, Medicare beneficiaries eligible for full Medicaid benefits living in long-term care facilities (LTC duals) accounted for 270,000 hospitalizations. And, almost a third (approximately 80,000) of these hospitalizations were caused by six potentially avoidable conditions: bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, chronic obstructive pulmonary disease or asthma, and skin ulcers.

But, the authors, continued, “…real progress has been made to improve the health and wellbeing of some of our country’s most vulnerable citizens.” In recent years, the overall rate of hospitalizations declined by 13 percent for dually eligible Medicare and Medicaid beneficiaries. But there have been even larger decreases in hospitalization rates for potentially avoidable conditions among beneficiaries living in long-term care facilities.  Specifically, between 2010 and 2015, the hospitalization rate for the six potentially avoidable conditions listed above decreased by 31 percent for Medicare and Medicaid dually-eligible beneficiaries living in long-term care facilities.

Indeed, 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. 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, CMS reported. The federal agency pointed to several reasons for this improvement, including:

• An initiative launched in 2011 by the Medicare-Medicaid Coordination Office, CMS Innovation Center, and other partners to reduce avoidable hospitalizations among nursing facility residents in seven sites across the country.
• The AHRQ Safety Program for Long-Term Care significantly reduced catheter-associated urinary tract infections in hundreds of participating long-term care facilities nationwide, which helped prevent a recognized cause of hospitalizations in residents of these facilities.
• This work is in addition to the many other efforts and initiatives, including the Hospital Readmission Reduction Program, and systemic efforts to reduce readmissions through the Partnership for Patients.
• The efforts to align care with quality through accountable care organizations (ACOs), the bundled payments for care improvement models, and other delivery system reforms.

The brief concluded, “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 healthcare costs were saved from 2010 through 2015.”