Long-Term Care Survey Alert

Published on Mon Dec 23, 2013 PDF

Get Ready For Heavy Scrutiny Of Your Hospital Transfers

You may soon have a new quality measure to report to the Centers for Medicare & Medicaid Services (CMS): nursing home resident hospitalization rates. Why? The HHS Office of Inspector General (OIG) thinks you’re transferring residents to hospitals too often, costing Medicare big bucks.

So says a new OIG report released on Nov. 19, which examined Medicare nursing home resident hospitalization rates. Although hospital transfers are often very necessary for nursing home residents to receive the acute-level care they need, the OIG is blasting nursing homes for what the watchdog considers “high” hospitalization rates.

Beware: “Hospitalizations are costly to Medicare, and research indicates that transfers between settings increase the risk of residents’ experiencing harm and other negative care outcomes,” the OIG says. “High rates of hospitalizations by individual nursing homes could signal quality problems within those homes.”

The OIG’s study discovered that in fiscal year 2011, nursing homes transferred about one-quarter of their Medicare residents to hospitals for inpatient admissions, costing Medicare $14.3 billion in hospital expenses. Septicemia was the most common condition for causing nursing home residents’ hospitalizations, the OIG reports.

And although those hospitalization rates varied widely across nursing homes, the OIG did find commonality among the nursing homes with the highest annual rates of resident hospitalizations: nursing homes located in Arkansas, Louisiana, Mississippi, and Oklahoma, as well as facilities with one, two, or three stars in CMS’ Five-Star Quality Rating System.

Watch for: CMS agreed with the OIG’s recommendations, which were for CMS to “develop a quality measure that describes nursing home resident hospitalization rates” and to “instruct State survey agencies to review the proposed quality measure as part of the survey and certification process.”

To view the entire OIG report, visit http://go.usa.gov/Wyb3.