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OIG Report: Nursing Home Hospitalizations Need Better Monitoring

As part of its 2013 Work Plan, the Office of the Inspector General (OIG) released a report, “Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring” (November 2013) that examines the rate of nursing home residents that were transferred to hospitals in FY 2011. The report notes that one quarter of nursing home residents were transferred to hospitals in 2011, which amounted to $14.3 billion in Medicare reimbursements. The 2013 Alliance for Quality Nursing Home Care’s quality report on SNF care showed a gradual reduction in hospitalizations from 2007-2011, but the OIG’s research on 2011 hospitalization rates contends that this is area is a growing concern. Recent news headlines show the hospital and long term care communities’ concerns about hospital readmissions and the “Two Midnight Rule” and its impact on payments, and the recommendations made in this report will further the cause to reduce readmissions.

The report found that annual hospitalization rates varied due to several factors – geographical location, size, Five Star Quality Rating, and type of ownership. It also noted several non-clinical factors for hospitalizations exist as well, including the availability/training of nursing staff at the facility, resident and/or family member preferences, and physician availability and/or preferences. States with the highest level of hospitalizations were Arkansas, Louisiana, Mississippi and Oklahoma. Generally, nursing homes with one, two or three stars on the Five Star Quality Rating System had higher hospitalization rates than the four or five star rated facilities, even though rehospitalizations is not one of the Quality Measures calculated for that rating . . . yet.

The most common diagnoses that sent nursing home residents to hospitals were septicemia, pneumonia, and congestive heart failure. Hospitalizations for septicemia-related diagnoses alone accounted for 21% of Medicare’s 14.3 billion spend on these hospitalizations. Some additional trouble areas that required SNF residents being transferred to hospitals include common issues in nursing homes – urinary tract infections, aspiration pneumonia, and delirium/dementia/other amnestic and cognitive disorders.

The OIG made two recommendations in this report, both of which CMS concurred with and will be implementing soon. The first is to develop a Quality Measure (QM) that calculates nursing home rates of hospitalizations and put it on Nursing Home Compare so the public can access it. CMS notes that it is developing a measure that will be put out later in 2013 and will measure long-stay residents that are hospitalized. The second recommendation was to instruct survey teams to make a review of resident hospitalizations part of the survey process once the new QM is in place. The OIG states that providing this information to nursing facilities would help them with quality improvement and other practices in their facilities, so be on the lookout for this new QM in the near future.