INTERACT Contributes to Fewer Nursing Home Hospitalizations
Interventions to Reduce Acute Care Transfers or INTERACT™ was implemented in phase I of The Centers for Medicare & Medicaid Services’ initiative to reduce avoidable hospitalizations for nursing home residents.
There are more than 1.6 million Americans currently living in nursing homes, and approximately 60 percent are sent to emergency rooms and 25 percent are admitted to a hospital in a year. Approximately one in five people who are discharged from a hospital to a skilled nursing facility (SNF) are readmitted within 30 days. Although hospitalizations are often required for medical reasons, experts suggest that 28 to 40 percent of these admissions could be avoided with enhanced care in the SNF. Avoiding these admissions would reduce hospital complications which are common in older people, and save Medicare billions of dollars over the next several years.
Components of Interventions to Reduce Acute Care Transfers or INTERACT™, a quality improvement program designed by researchers at Florida Atlantic University, were implemented in phase I of The Centers for Medicare & Medicaid Services’ (CMS) Initiative to Reduce Avoidable Hospitalizations among Nursing Home Residents. CMS’ initiative, made possible by the Affordable Care Act, is designed to affect hospitalization rates by directly changing practices at the facility level.
This initiative involves seven enhanced care and coordination providers (ECCPs) consisting of academic institutions, quality improvement organizations, a health care provider network, and a hospital association. Since 2013, these ECCPs have partnered with 144 nursing facilities in seven states (Alabama, Indiana, Missouri, Nebraska, Nevada, New York, and Pennsylvania) to implement strategies aimed at reducing hospitalizations and improving care for fee-for-service, and long-stay nursing facility residents whose care is funded through Medicare, Medicaid, or the Veterans Administration.
Preliminary findings from the initiative show that all seven sites generally showed a decline in all-cause hospitalizations and potentially avoidable hospitalizations, with four sites showing statistically significant reductions in at least one of the hospitalization measures. During this period, all sites also generally showed reductions in Medicare expenditures relative to a comparison group, with statistically significant declines in total Medicare expenditures at two sites.
“In order for skilled nursing facilities, home health agencies, and assisted living facilities to be able to manage older people better without sending them back to the hospital they need education, guidance, and tools they can use in everyday practice. And that’s what INTERACT is,” said Joseph G. Ouslander, M.D., chair of the Integrated Medical Science Department, senior associate dean of geriatric programs, and a professor in FAU’s Charles E. Schmidt College of Medicine, who designed and developed INTERACT. “Using INTERACT’s standardized protocols, many residents of nursing homes experiencing an acute event can be treated without complications or the stress of a hospital transfer saving Medicare upwards of $10,000 or more.”
Following review and approvals from CMS, the ECCPs began implementing their initiatives in the partner nursing facilities in February 2013. Under CMS guidance, each ECCP designed its own interventions within the initiative, and all seven of the ECCP sites chose to use various components of FAU’s INTERACT. Ouslander was involved in providing training for all of the ECCPs who directed implementation of the program in the 144 SNFs.
Approximately two-thirds of nursing facility residents are enrolled in Medicaid, and most also are enrolled in Medicare. The CMS evaluation measures include a broad set of measures such as hospitalization rate, readmission rate, quality of care, patient experience, and Medicare expenditures.
“Hospitalization is disruptive for older people and their families and puts them at greater risk for complications such as infections,” said Ouslander. “Trips to the hospital also increase the likelihood of reduced functioning after returning to a nursing home, home, or an assisted living facility. Beyond the potential negative physical, emotional and psychological impacts on assisted living residents, avoidable admissions also cost the Medicare program billions of dollars that could be reinvested to further improve the quality of care.”