CMS Reports Sharp Reduction in Avoidable Hospitalizations Among Long-Term Care Facility Residents

January 20, 2017
Policy Snapshot

A data brief released by the Centers for Medicare & Medicaid Services (CMS) this week, noted dramatic reductions in avoidable hospitalizations over the last several years. CMS along with the help from the Affordable Care Act, and working with other federal government agencies, states, patient organizations, and others began to identify and prevent health conditions that have caused long-term care residents to be unnecessarily hospitalized.

CMS found 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.”

CMS noted that “Through the concerted effort by CMS and many others to address these potentially avoidable conditions, 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 we have seen 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.”

“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.[1] 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,” the report stated.

CMS acknowledges the success would not be possible without those committed to working and directly serving older adults and contributes some of the success to initiatives such as the CMS Innovation Center partnership to reduce avoidable hospitalizations among nursing facility residents. The initiative, which is in seven sites across the country, is aimed at keeping dually-eligible long-term care resident health by focusing on preventable conditions that lead to hospitalizations.

To read more about the CMS data click here.