The four-year project began February 1, and is meant to reduce the costs to Medicare and Medicaid associated with those hospitalizations, while providing better care for nursing home residents.
“Each year, it costs the Medicare and Medicaid funds billions of dollars for hospitalizations that could have been prevented,” said Michael Jones, Director of communications at Alabama Quality Assurance Foundation, the non-profit company overseeing the project.
AQAF is under contract to serve as Alabama’s Medicare Quality Improvement Organization.
A significant number of hospitalizations of Medicaid and Medicare nursing home residents can be prevented, Jones said, by providing additional training for nursing home staff.
An average, Jones said a single hospital admission costs about $9,000. AQAF estimates that in 2011 the total costs for those potentially avoidable hospitalizations cost Medicare and Medicaid funds between $7 and 8 billion.
The project, funded by the Centers for Medicare & Medicaid Services, will put 23 registered nurses in 23 nursing homes across 14 Alabama counties.
The locally-hired nurses will work with nursing home staff to help them identify ways to better care for the residents, focusing on a continuity of care, Jones said, “Where the same people work with the same residents.”
By providing that continuity of care, Jones said nursing home staff can better recognize when a resident may be having a problem, and can address that problem early thereby preventing a hospitalization.
Pressure ulcers – commonly called bedsores – are common in nursing homes, Jones said, and are very preventable. Such injuries can become badly infected, requiring hospitalization. By providing that extra training, Jones said that staff can prevent such injuries.
Almost two-thirds of nursing home residents are enrolled in Medicaid, and most are also enrolled in Medicare, according to AQAF. In a press release, the company cites research that found that approximately 45 percent of hospitalizations among Medicare-Medicaid enrollees receiving either Medicare skilled nursing facility services or Medicaid nursing facility services could have been avoided.
At the end of the four year project, “It will be scrutinized and analyzed, and it will tell us if we succeeded or didn’t. And hopefully, the point is that they will take the things that did work and spread them out in the wider setting instead of just seven states,” Jones said.
“It’s an opportunity for us…to have a lot of extra support and move us forward, and it has the potential to impact the industry as a whole,” said Brantley Newton, administrator for Jacksonville Health and Rehab.