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OIG Recommends Additional Quality Measure for Medicare Nursing Home Resident Hospitalization Rates

In November 2013, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) issued a report which called for additional quality measures (QMs) of Medicare nursing home resident hospitalization rates. The application of QMs to nursing home hospitalization rates is intended to resolve identified discrepancies between hospitalization rates for Medicare- and Medicaid-certified nursing homes. In its study, the OIG found that one quarter of Medicare nursing home residents experienced hospitalization in FY 2011, which resulted in $14.3 billion in Medicare spending. Among nursing homes linked to the highest rates of resident hospitalization were:

  1. Nursing homes located in Arkansas, Louisiana, Mississippi, and Oklahoma;
  2. Nursing homes receiving fewer than four stars according to CMS’ Five-Star Quality Rating System;
  3. Large and medium-sized nursing homes compared to smaller nursing homes;
  4. For-profit nursing homes compared to government-owned nursing homes and nonprofit nursing homes.

In addition to the increased Medicare spending, high hospitalization rates may further suggest problems relating to the quality of these homes with high hospitalization rates. As such, the OIG recommended to CMS the following: (1) develop a QM that describes nursing home rates of resident hospitalization and publicly report this information on its Nursing Home Compare website allowing residents and families to review and compare nursing homes based on this criteria; (2) instruct state agency surveyors to review nursing home rates of resident hospitalization as part of the survey and certification process, which could help surveyors identify areas of concern within individual nursing homes. CMS concurred with each of the OIG’s recommendations.

Based on the OIG’s report, it is important for providers to conduct self-assessments of their hospitalization rates in order to identify any potential or existing quality issues needing to be addressed. If you have any questions regarding the OIG’s recommended quality measures or how they might affect your institution, please contact an experienced healthcare attorney at Wachler & Associates at 248-544-0888 or wapc@wachler.com.