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We All Care, a Whole Awful Lot

When we entered Conference Room 1 of the Federal Reserve building in Birmingham, Alabama, rows of brightly colored gift bags greeted us at our seats.

Inside was a copy of the agenda for the next two days, a logo’d coffee mug or journal from our host organization, the Alabama Quality Assurance Foundation, a Nursing Facility Initiative sugar cookie, a “Welcome to the City of Birmingham” pamphlet with recommendations for restaurants and sightseeing (we stopped by the Birmingham Civil Rights Institute museum before heading to the airport) and a 3x5 card with a quote on it:

“Unless someone like you cares a whole awful lot, nothing is going to get better, it’s not.” – Dr. Seuss

That same quote is scrawled alongside a Lorax atop a Trufulla tree on a canvas in my Las Vegas office. I immediately felt right at home among my peers who have been working to improve the quality of care and reduce potentially avoidable hospitalizations among long-term care residents in skilled nursing facilities across the country since 2012.

Together, we spent two days sharing best practices and program challenges in an effort to learn from one another about how to best assist our partnering facilities in the continued implementation of Phase 2, the payment reform component of the Nursing Facility Initiative demonstration project, known as the Admissions and Transitions Optimization Program, or ATOP, in Nevada and Colorado.

We were joined by representatives from the Centers for Medicare & Medicaid Services and their program evaluation subcontractors, who shared results from 2018 chart audits and Year 1 (December 2016-September 2017) program performance, respectively.

We learned that we all work diligently to track and monitor our participating facilities’ progress with reducing potentially avoidable hospitalizations; we all struggle with practitioner engagement; and we all have dedicated resources to finding innovative ways to continue this important work long after it ends in September 2020. Our clinical teams are dedicated to improving the quality of life for some of our most vulnerable citizens.

We all care, a whole awful lot.

Six Enhanced Care and Coordination Providers across seven states have partnered with 263 skilled nursing facilities to test whether a new payment model will reduce avoidable hospitalizations and related expenditures for 27,425 eligible long-term care residents by offering financial incentives to participating facilities and practitioners to provide in-house care to high-acuity residents with one of six qualifying conditions (urinary tract infections, pneumonia, skin infections/cellulitis, fluid/electrolyte disorder, chronic obstructive pulmonary disease/asthma and congestive heart failure), rather than transferring them to the hospital.

While Year 1 findings for Phase 2 of the program were not definitive, payment reform-only facilities, including the 21 ATOP2-participating skilled nursing facilities in Colorado, “showed promising reductions in utilization and expenditures,” according to a recent evaluator report. And while overall, the clinical-intervention-plus-payment-reform facilities have not yet experienced reductions in utilization and expenditures beyond what was previously achieved in Phase 1, the 13 clinical-intervention-plus-payment-reform facilities in Nevada did see slight reductions in acute-care transitions and expenditures for all-cause and six-qualifying-condition transfers. There’s still much to be done.

In partnership with CMS, over the next 18 months, ATOP2 team members will continue to provide education on and advocate for the early identification and treatment of changes in condition for our nursing home residents, while promoting the use of Interventions to Reduce Acute Care Transfers (INTERACT) tools to improve the communication flow between nursing facility staff and practitioners. We will continue to brainstorm new ways to engage those practitioners in this project and share our successes (and failures) widely so our peers can learn from them.

Our trip to the Magic City was inspiring and affirming, and it reminded me just how important the work we do on behalf of the populations we serve is to the health of our communities, our states and our country. This quote from Martin Luther King, Jr., sums up our work quite fittingly:

“If you can’t fly, then run, if you can’t run, then walk, if you can’t walk, then crawl, but whatever you do, you have to keep moving forward.”

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