Nursing facility residents account for a significant portion of overall Medicare spending, in part due to relatively high rates of hospitalization. Many of these hospitalizations, however, are potentially avoidable, cost more than alternative clinical options, and can be detrimental to the resident's well-being.
According to the Kaiser Family Foundation, there are many reasons for a disproportionate level of avoidable hospitalizations among nursing facility residents including limited on-site clinical staff capacity, physician preferences toward hospitalization, liability concerns, lack of relationships between clinicians and families, and lack of advance care planning, among others.
Research publicized by the Center for Medicare and Medicaid Services (CMS) indicates that approximately 45 percent of these hospitalizations could be avoided, representing a potential for billions of dollars in savings and improved resident care. Utilizing appropriately-targeted, evidence-based interventions to reduce these unnecessary hospitalizations, the RAVEN facilities will help achieve these important outcomes.
In 2012, Pennsylvania ranked third in the United States in the percentage of people over the age of 65 and fourth in the number of people over the age of 85. It is projected that by 2030, nearly one-quarter of Pennsylvanians will be age 65 or older, and the number of those 85 and older will increase by over 50 percent.
Across the state, many of the most vulnerable of this population reside in one of 89,000 beds in 720 nursing facilities. The Hospital Referral Regions (HRR) within focus for this initiative vary in their Medicare costs, hospital readmission rates, and Medicare-Medicaid enrollees as a percentage of nursing facility residents. The focus geography includes areas which are worse than national averages in these categories, making this region a prime candidate for this initiative.