Hospital admission rates show need for new nursing home quality measure , OIG and CMS say

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OIG and CMS: Hospital admission rates show need for new nursing home quality measure
OIG and CMS: Hospital admission rates show need for new nursing home quality measure

One in four nursing home residents on Medicare was hospitalized in 2011, costing the program $14.3 billion, according to a new report from the Department of Health and Human Services Office of Inspector General. In light of its findings, the OIG has recommended a new quality measure to track hospital admissions.

Investigators utilized government databases to gather information about all Medicare beneficiary transfers from nursing homes to hospitals for inpatient stays. The analysis considered all Medicare beneficiaries who spent at least one day in a Medicare- or Medicaid-certified nursing home in 2011, including long-term residents whose stays were not covered by Medicare.

The average hospitalization rate for these residents was 25% nationally, according to the report. Facilities in the Southeast and Oklahoma had the highest hospitalization rates, with Louisiana's reaching 38%. For-profit facilities' annual hospitalization rate was 26.5%. The rates for not-for-profits and government-run facilities were below the national average.

Quality measures (QMs) used in the government's Five-Star Rating System also correlated to hospitalization rates, the OIG found. Low staffing levels, in particular, related to higher hospitalization rates.

The report authors urge the Centers for Medicare & Medicaid Services to create a QM to reflect hospitalization rates. This could track a nursing home's overall rate, or it might identify those with higher than average hospitalizations for particular conditions. Septicemia and pneumonia are the most common conditions leading to hospitalization, the OIG found. The above-average reimbursement rate for septicemia treatments is one reason for the high Medicare costs associated with patients admitted from nursing homes.

CMS concurred with the recommendation to develop a quality measure. It is developing a 30-day all-cause hospital readmissions measure for SNFs and plans to submit this to the National Quality Forum for approval by the end of the year, the agency stated in its response to the report.

Click here to access the complete document, released Tuesday.

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