Evaluating initiative to reduce avoidable hospitalizations of nursing home residents: facility perspective

During the first year of data collection, RTI interviewed 95 key nursing and administrative staff from the 251 participating facilities. Interview topics included Initiative implementation, billing practices, perceived Initiative effectiveness, and related topics. Telephone interview findings highlighted good progress in implementation and use of the new billing codes, with 76% of facilities reporting that they have submitted one or more claims using the new billing codes. The majority of interviewees (72%) believed the components of the Initiative help reduce avoidable hospitalizations. Other key successes at this early stage included enhanced staff skills as a result of additional training on the six qualifying conditions and a general perception of facility-wide process change toward focusing more on treating residents in-house. Despite generally strong facility participation, interviewees reported a few early challenges, including the substantial time investment to document changes in qualifying conditions to meet claims submission requirements.