Inspector General Scrutinizes LTC Industry on Rehospitalizations

Government inspectors say there’s not enough attention being paid to the readmissions problem in long-term care settings, specifically nursing homes. 

A recent study by the Office of the Inspector General (OIG) found that of the 825,765 Medicare residents who stayed in nursing homes for at least one day in fiscal year 2011, 24.8% experienced hospitalizations.

As this population cost Medicare $14.3 billion during that year—33% more per stay than for the average Medicare hospitalization—OIG’s study stresses the need for improved quality measures that detail hospitalization rates within these care settings.

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The most common illnesses that drew nursing home residents back to the hospital were for septicemia (13.4%), pneumonia (7%) and congestive heart failure (5.8%).

Septicemia alone accounted for 21% of Medicare spending on nursing home resident hospitalizations, amounting to almost $3 billion in FY 2011, according to OIG’s findings.

Nursing homes routinely collect resident assessment data during a nursing home stay and the Centers for Medicare & Medicaid Services (CMS) converts this data into 18 quality measures.

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Examples of quality measures indicate how well a nursing home provides care to its residents, including the percentages of residents who report moderate to severe pain, residents who were appropriately given the seasonal influenza vaccine, and the percentage of residents who have lost significant amounts of weight.

While nursing homes routinely collect resident assessment data when reporting quality measures to CMS, there is not a measure of how often nursing homes hospitalize their residents.

Annual rates of Medicare resident hospitalizations varied widely across nursing homes, with states like Arkansas, Louisiana, Mississippi and Oklahoma representing the highest rates.

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“Hospitalizations of nursing home residents are necessary when physicians and nursing staff determine that residents require acute-level care,” writes OIG in the study. “However, the higher-than-average resident hospitalization rates of some nursing homes in FY 2011 suggest that some hospitalizations could have been avoided through better nursing home care.”

Because of this, OIG recommends that CMS develop a quality measure that describes nursing home rates of resident hospitalization, as well as instructing state agency surveyors to review nursing home rehospitalization rates as part of the certification process. 

“Examining these data could help surveyors identify areas of concern—such as infection control practices in homes with high rates of hospitalizations for septicemia—within individual nursing homes,” writes OIG. 

Access the study

Written by Jason Oliva