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Policy: Entitlements

IG: Feds need new way to measure nursing home quality

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Health,Watchdog,Health and Human Services,Health Care,Medicare and Medicaid,Entitlements,Kelly Cohen,Inspectors General

A high number of nursing home residents on Medicare are being hospitalized, showing a need for new way to measure nursing home quality, the U.S. Health and Human Services inspector general said this week.

More than 825,000 Medicare residents in nursing home care were transferred to hospitals in 2011 — an action costing the agency $14.3 billion. At 1,059 nursing homes (nearly 7 percent of nursing homes studied), more than two of five stays ended in hospitalization.

Each hospitalization cost $11,255 — an amount one-third higher than the average price of hospitalizing Medicare patients who were not in nursing home care.

The most frequent cause of hospitalization was septicemia, a life-threatening bloodstream infection.

The IG found that the homes with highest hospitalization rates were in Arkansas, Louisiana, Mississippi and Oklahoma. Louisiana's rate of hospitalization was greater than one patient out of every three, much higher than the national average of roughly one patient out of every four.

Unsurprisingly, nursing homes given a one-, two- or three-star rating on the agency's judging system had higher rates of hospitalization than those with four- or five-star ratings. The system, created by the Centers for Medicare and Medicaid Services, judges nursing homes on three parts including inspection surveys, quality assessments and staffing numbers.

The study compared hospitalization rates based on “the nursing home’s geographic location, its size, its rating on CMS’ Five-Star Quality Rating System, and the category of its ownership."

The IG also found that medium- and large-sized homes hospitalized more residents than smaller ones. For-profit homes had high rates as well, compared with government-owned and nonprofit homes.

What does all of this mean? Better nursing home care could have helped avoid the higher-than-average rate of hospitalization in 2011.

CMS agreed to develop a new publicly available quality measure to show the rate of hospitalization, hoping that allowing the public to compare rates across nursing homes would incentivize nursing homes to rescue avoidable hospitalizations. In addition, CMS agreed to urge state-level survey agencies to use the new QM to identify specific areas of concern — such as infection control practices — within individual nursing homes.

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