A federal watchdog’s announcement this week that it plans to more closely scrutinize “possibly preventable” readmissions of skilled nursing patients to hospitals underscores the federal government’s laser focus on this core quality metric. 

A planned audit by the Health and Human Services Office of the Inspector General is yet another expansion of its oversight of unnecessary hospitalizations of Medicare-eligible skilled nursing residents. Now is the time for facilities to get their audit readiness plans in order, a healthcare and reimbursement attorney said Wednesday.

“This is a reminder for SNFs to keep an eye on readmissions at their facilities and to understand the rate of readmissions and related reasons for the readmissions,” Alice Harris of Nexsen Pruet told McKnight’s Long-Term Care News.

“The audit activity related to this area is likely to increase, and it could be problematic for SNFs if the SNFs are not ensuring they have safeguards to prevent rehospitalizations to the extent possible.”

In the past, OIG has reviewed transfers to hospitals of patients with urinary tract infections, and concluded in 2019 that SNFs weren’t providing UTI prevention and detection according to care plans.

Citing studies that show that 78% of transfers of long-term care residents to hospitals were for one of five conditions — pneumonia, congestive heart failure, UTIs, dehydration, and chronic obstructive pulmonary disease/asthma — OIG will review hospitalizations of SNF residents with any of those conditions to discover whether their facilities could have done more to prevent the condition and subsequent transfer. 

The OIG also found that sepsis is preventable if the underlying cause is preventable and will include it in this audit.

The nation’s worst performing nursing homes when it comes to hospital readmission are already docked financially, and skilled nursing facilities aren’t the only providers targeted for too often allowing patients to need more acute care. Hospitals have faced such scrutiny and penalties for more than a decade. Last year, the Centers for Medicare & Medicaid Services reduced payments to nearly half of hospitals.

Since 2018, SNFs entire Value-Based Purchasing program has been built around readmission performance. Earlier this year though, a JAMA study by researchers at UPenn and Stanford found that just 52 skilled nursing facilities of nearly 15,000 were able to improve enough from a poor baseline score to avoid a financial penalty, despite large reductions in readmission rates.

Taken all together, the financial incentives, penalties and increased audit activity reflect a concerted federal policy initiative to reduce rehospitalizations.

“While adding audit activity on top of quality metrics and potential penalties feels duplicative, the audit activity is predictable when an area of concern is continuing to be a problem area,” she said.

The February JAMA study noted above found that nearly one-quarter of those admitted to SNFs are readmitted to a hospital within 30 days, and those readmissions are associated with a quadrupled mortality rate within 6 months.

In a blog Tuesday, Harris said  facilities should prepare for even more oversight by:

  1. Examining policies, procedures and practices related to the identification of the six conditions identified by the OIG, including the content of care plans and implementation of care plans;
  2. Educating and training all staff on the detection, prevention, treatment and care planning related to the six conditions;
  3. Conducting a data analysis of trends related to the frequency and cause of inpatient hospitalizations, and craft a response plan to examine patterns; and
  4. Using information from a data analysis or a random sample to self-audit.