CMS tests payment model for skilled nursing, ups reimbursement for on-site assessments

The Centers for Medicare and Medicaid Services on Thursday said it will test a new payment model that would align reimbursement rates for comprehensive assessments done at skilled nursing facilities with rates already paid to hospitals.

Currently, Medicare pays physicians less for a comprehensive assessment done at a skilled nursing facility than for the same assessment at a hospital, CMS said.

The new CMS model equalizes the payments between the sites to reduce avoidable hospitalizations.

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In addition, participating skilled nursing facilities will receive payments to provide additional treatment for common medical conditions that often lead to hospitalization and greater expense, according to CMS. For example, the money could be used to purchase new equipment to provide intravenous therapy and cardiac monitoring.

The new, four-year payment initiative begins in the fall of 2016 at six facilities awarded contracts as enhanced care and coordination providers: Alabama Quality Assurance Foundation in Alabama; HealthInsight of Nevada, in  Nevada and Colorado; Indiana University in Indiana; The Curators of the University of Missouri in Missouri; The Greater New York Hospital Foundation in New York; and UPMC Community Provider Services in Pennsylvania.

"Smarter spending can improve the quality of on-site care in nursing facilities and the assessment and management of conditions that too often now lead to unnecessary and costly hospitalizations," said Tim Engelhardt, director of the Medicare-Medicaid Coordination Office.

Twitter: @SusanJMorse

This is the next phase of an initiative to reduce avoidable hospitalizations among nursing facility residents. In 2012, CMS  tested a model at seven sites to improve care through clinical and educational interventions at 143 long-term care facilities.

Early results show success in a decline in hospitalizations and potentially avoidable hospitalizations, and reductions in Medicare spending. The first phase will continue through 2016.

The initiative is a collaboration of the CMS Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation, both created by the Affordable Care Act.

Twitter: @SusanJMorse