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January 25, 2018

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Medical Coding News Archives

Hospitalization Rates Drop Among LTC Patients

February 27, 2017:

The Centers for Medicare and Medicaid Services (CMS) had good news to report in January: The hospitalization rate of long-term care (nursing home) patients dually eligible for Medicare and Medicaid fell by 13 percent between 2010 and 2015. The improvement in the hospitalization rate for avoidable conditions had an even more dramatic drop—31 percent.

By “avoidable conditions,” CMS is referring to bacterial pneumonia, urinary tract infections, congestive heart failure, dehydration, chronic obstructive pulmonary disease or asthma, and skin ulcers. Of the 270,000 dually-eligible beneficiaries in long-term care facilities who were hospitalized in 2015, 80,000 of these admissions were prompted by one of these conditions. The improvement occurred in all 50 states, CMS reports.

The agency credits several factors for helping to lower the number of hospitalizations among this vulnerable group of beneficiaries. For example, the CMS Innovation Center and partners launched an initiative in 2011 in seven sites across the nation to lower avoidable hospitalizations among long-term care residents. In addition, the Agency for Healthcare and Research Quality Safety Program for Long-Term Care focused on reducing the incidence of urinary tract infections due to catheters at LTC facilities. CMS also gives a nod to the Hospital Readmission Reduction Program, accountable care organizations, and various other industry-led efforts to focus on quality improvement.

CMS notes that fewer hospitalizations indicate that LTC dually-eligible beneficiaries are receiving better preventive care. These lower rates also mean lower expenses for Medicare and Medicaid.


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