AQAF awarded federal grant to test new payment model in nursing facilities

Alabama Quality Assurance Foundation (AQAF) has received a new $18.5 million grant from the Centers for Medicare & Medicaid Services (CMS) to test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations. AQAF is one of only six organizations in the nation to implement the initiative. This new four-year payment phase of the Initiative is slated to begin fall 2016.

CMS announced it will test whether a new payment model for nursing facilities and practitioners will further improve the quality of care received by nursing facility residents, reduce avoidable hospitalizations, and lower combined Medicare and Medicaid spending.

Since 2012, CMS has funded seven Enhanced Care and Coordination Providers (ECCPs) to test various models to improve care for long-stay nursing facility residents through clinical and educational interventions. The ECCPs currently collaborate with 143 long-term care facilities to provide on-site staff for training and preventive services and to improve the assessment and management of medical conditions. According to CMS, 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. In addition, all sites generally showed reductions in Medicare expenditures relative to a comparison group in 2014, with statistically significant declines in total Medicare expenditures at two sites.

The new model would equalize the payments between the sites of care with both hospitals and nursing homes. Removing potential barriers to effective treatment within a facility can improve the residents’ care experience and mitigate the need for disruptive and costly hospitalizations. For example, participating skilled nursing facilities may be expected to enhance their staff training and purchase new equipment to improve their capacity to provide intravenous therapy and cardiac monitoring.

“This Initiative has the potential to improve the care for the most frail, most vulnerable Medicare-Medicaid enrollees—long-stay residents of nursing facilities,” said Tim Engelhardt, Director of the Medicare-Medicaid Coordination Office. “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.”

The new model will be subject to a rigorous independent evaluation to determine the effects on cost and quality of care. ECCP awardees will implement the payment model with both their existing partner facilities, where they provide training and clinical interventions, and in a comparable number of additional facilities to be recruited over the next several months.

Birmingham-based AQAF provides health care quality improvement services to clients in the public and private sectors. AQAF is a member of atom Alliance, serving as a Medicare Quality Improvement Network – Quality Improvement Organization (QIN-QIO) for the state of Alabama. For more information, visit