GNYHA Foundation’s New York–Reducing Avoidable Hospitalizations (NY–RAH) project recently shared its project findings from the Nursing Facility Initiative (NFI) during the virtual Centers for Medicare & Medicaid Services (CMS) annual NFI meeting. Sponsored by GNYHA Foundation and the Icahn School of Medicine at Mount Sinai, NY–RAH is one of six projects across the US participating in the NFI.

The NFI is sponsored by the Federal Medicare-Medicaid Coordination Office in collaboration with the Center for Medicare & Medicaid Innovation. The six participating organizations shared successes and challenges, and CMS and its NFI contractors provided feedback. While the NFI project concludes later this year, GNYHA will expand on the lessons learned and best practices through new stakeholder partnerships with long-term care membership organizations and New York State agencies.

CMS created the NFI in 2012 to test whether providing additional clinical supports and interventions would improve the care of long-stay nursing facility residents. The NFI was renewed in 2016, with a second phase enabling participating facilities and practitioners to receive payment incentives through Medicare Part B to manage long-stay residents for specific conditions in the nursing facility.

GNYHA’s Principal Findings

GNYHA reported to CMS that the additional project staff were welcomed by most of the facilities, which have often struggled to retain professional staff. Regarding the NFI’s target population, incentivizing facilities to focus on long-stay residents was challenging due to inadequate Medicaid rates to care for these residents. Instead, participating nursing facilities focused more on the short-stay population, closely monitoring 30-day readmission rates to avoid financial penalties. While the NFI’s payment incentives enhanced the daily rate for treating certain conditions at the nursing facility—and was appreciated by the nursing facility leadership—most facilities still judged the enhanced payment as insufficient to make meaningful systemic change.

GNYHA also reported that high turnover rates at the leadership and frontline staff levels contributed to difficulties in sustaining process improvements and intervention success. GNYHA successfully worked on targeted quality improvement projects with nursing facilities using current data to determine the process breakdowns of recent hospitalizations. These project successes were more likely to be sustained. GNYHA also reported that advance care planning and completion of advance directives improved over time at the nursing facilities. These strategies addressed the residents’ care goals and end-of-life wishes, reduced avoidable hospitalizations, and bettered the quality of life for long-term care residents.