OPTIMISTIC program reduces avoidable hospitalizations

Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in NextAvenue.com, Journal of Active Aging, Cancer Today, Kaiser Health News, the Connecticut Health I-Team and other outlets. She is a senior fellow at the Center for Health Policy and Media Engagement at George Washington University and co-produces the HealthCetera podcast.

Photo: SalFalko via Flickr

A nursing home demonstration project in Indiana has reduced avoidable hospitalizations among residents by a third, according to a recently released independent evaluation of OPTIMISTIC, (Optimizing Patient Transfers, Impacting Medical quality and Improving Symptoms: Transforming Institutional Care).

OPTIMISTIC is a Centers for Medicare and Medicaid (CMS) demonstration program designed to improve chronic disease management and boost staff education and training.

The program, developed and implemented by clinical researchers from the Indiana University Center for Aging Research, reduced these events a striking 33 percent, according to the analysis by RTI International, a Massachusetts-based, independent, nonprofit research institute.

RTI’s report also found that OPTIMISTIC eliminated nearly one in five of all hospitalizations – both avoidable and unavoidable. Medicare expenditures fell $1,589 per nursing home resident per year, resulting in a spending reduction of nearly $13.5 million overall and a net savings of over $3.4 million from 2014 to 2016. The review was prepared at the request of the Center for Medicare and Medicaid Innovation (CMMI), which funds OPTIMISTIC.

It’s one of seven demonstration projects across the country supported by CMS Innovations through the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents by placing additional resources in nursing homes. Other demonstrations are taking place in Alabama, Nebraska, Nevada, Missouri, New York City and Pennsylvania. The report analyzed year three of these demonstrations, which took place in 2015.

OPTIMISTIC’s initial four-year initial phase focused on enhanced clinical care. Nurses and nurse practitioners were embedded in 19 central Indiana nursing homes, providing direct support to long-stay residents and their families, as well as educating and training facility staff. These specially trained health professionals also led care management reviews of long-stay patients to optimize chronic disease management, reduce unnecessary medications and clarify care goals.

Long-stay nursing home residents typically have high rates of multiple chronic illnesses including dementia, according to Kathleen Unroe, M.D., a scientist at the IU Center for Aging Research and Phase I principal investigator. “Keeping these complex patients in the nursing facility is often the right choice. There is a lot of care we can provide in the nursing facility setting – a familiar place with staff and providers who know them – that spares the resident and their family the difficulties associated with a transfer to a hospital. When we can do that safely we should,” she said in a statement.

The care of long-term nursing home residents with these conditions is often fragmented by hospitalizations and re-hospitalizations which is especially burdensome to frail older adults. The likelihood of reduced functioning and overall negative impact on their health after discharge from the hospital is significant.

As this story describes, CMS research has estimated that up to 45 percent of hospitalizations of nursing facility residents could be prevented with well-targeted interventions, saving billions in annual Medicare spending.

OPTIMISTIC is now in Phase II, which added 25 additional nursing homes throughout Indiana to the 19 that participated in the initial phase. They are implementing a new payment model which incentivizes nursing facilities, as well as their medical staffs, to provide higher levels of care on site rather than sending residents to the hospital.

For journalists

  • What are nursing homes in your area doing to cut down on avoidable hospital admissions?
  • How do these innovations compare up among local facilities?

Resources

  • Check this AHCJ page for links to state websites on nursing homes
  • This tip sheet from ProPublica’s Charles Ornstein offers pointers for using Nursing Home Compare
  • CMS explains their Nursing Home Quality Initiative here
  • RAND’s nursing home section has several reports on quality, cost and disparities

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