The Office of the Inspector General has recommended that the Centers for Medicare & Medicaid Services develop a measure to determine the rate nursing home residents are being admitted to hospitals due to a deterioration of their medical condition.
According to the OIG, about one quarter of Medicare recipients were transferred into hospitals from Medicare-eligible nursing homes in fiscal 2011, costing the program at least $14 billion. The hospitalization rates were significantly higher in the Southeast, running as high as 38 percent in states such as Louisiana, McKnight's Long Term News reported. The OIG study reported that for-profit nursing facilities had higher rates of hospital readmissions than not-for-profit and government-operated facilities.
Among the reasons the costs are so high is that patients are often transferred for health conditions that require an intensive amount of treatment, such as septicemia and pneumonia, the OIG found. The latter is among the most treatable of medical conditions but often require lengthy hospital stays.
The nursing home versus hospital dynamic has caught the eye of healthcare finance executives and policymakers in recent years, primarily because of the issues surrounding observation care. Hospitals may transfer Medicare patients to nursing homes at their discretion, but Medicare will not pay for patients who are transferred directly from observation care status, prompting debate about formulating a policy that mitigates the risk of hospitals being audited while sparing patients and their families large nursing home expenses. The OIG study only begins to shed light on patient traffic moving in the opposite direction, from skilled nursing facilities to hospitals.
The CMS concurred with the OIG's findings, McKnights reported, saying it would not only develop a quality measure on hospital admissions to rate nursing homes, but it would instruct inspection agencies on the state level to use it for rating purposes in the future.
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