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From Health Law Daily, March 4, 2014

Estimated 22 percent of Medicare patients on post-acute stays experienced adverse events

By Melissa Skinner, JD

An estimated 22 percent of Medicare beneficiaries on post-acute stays in skilled nursing facilities (SNFs) experienced adverse events according to a report released by the Office of the Inspector General (OIG). The report also revealed that an additional 11 percent of beneficiaries experienced an adverse event that resulted in temporary harm. Of the adverse events reported, physicians determined that 59 percent of the events were clearly or likely preventable. Over half of the patients affected by these events visited the hospital as a result and, in turn, it is estimated in August of 2011 these types of scenarios cost Medicare $208 million. As a result of these findings, OIG recommended that government agencies raise awareness about nursing home safety (OIG Report, No. OEI-06-11-00370, February 27, 2014).

Background. In the last decade, Medicare expenditures for SNF care have more than doubled. In 2000, Medicare paid $12 billion for SNF care costs, however that number increased to $28.4 billion for fiscal year (FY) 2011. Both CMS and the Agency for Healthcare Research and Quality (AHRQ) are responsible for quality assurance for health care in nursing homes. The AHRQ maintains a safety certification process which requires reporting safety data to Patient Safety Organizations (PSOs). While Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) provided that insurance plans operating out of health insurance exchanges cannot contract with any hospital with 50 or more beds that do not report safety data to a PSO, there is no similar requirement for SNFs as of yet.

The OIG report covered post-acute SNF stays, which are defined as stays that began within one day of a hospital release and lasted 35 days or less and which account for 70 percent of all SNF Medicare beneficiary stays. Specifically, the report investigated adverse events, or harm to a patient or resident as a result of medical care, among post-acute SNFs between 2008 and 2011.

Findings. Overall, the report’s data showed that 22 percent of Medicare patients on post-acute stays experienced an adverse event, with an additional 11 percent undergoing temporary harm as a result of that event. Specifically, the majority of those events, 79 percent, resulted in either an extension of time of the SNF stay or a transfer to a hospital for acute level care, either via emergency room visits or through inpatient admissions. Additionally, 14 percent of the adverse events required life-sustaining care, and 6 percent contributed to the patient’s death. The report also classified adverse events into three categories: 1) events related to medication, which made up 37 percent of the total adverse events; 2) events related to ongoing resident care, which also made up 37 percent of the events; and 3) events related to infections, which amounted to 26 percent of the adverse events reported.

Physicians found that 59 percent of the adverse events recorded were either clearly or likely preventable and attributed most of the events to substandard treatment, inadequate resident monitoring, and failing to provide treatment. Considering only the data from August of 2011, the OIG report estimated that 20,393 post-acute SNF patients were harmed and transferred to hospitals. The estimated cost to Medicare for these patients alone was approximately $208 million with approximately $136 million of those expenditures resulting from harms that were preventable.

Recommendations. Based on these findings, the OIG recommended that the Agency for Healthcare Research and Quality (AHRQ) and CMS raise awareness with regard to adverse events during post-acute SNF stays and promote increased safety through methods typically used to encourage hospital safety, In particular, the OIG suggested that AHRQ and CMS jointly produce and maintain a list of nursing home events and that both agencies should encourage the report of adverse events by nursing homes. AHRQ and CMS concurred with each of the recommendations and in comments to the draft of this report, CMS Administrator, Marilyn Tavenner, asserted that CMS is in the process of rule-making with regard to the adoption of quality assessment and performance improvement (QAPI) activities for nursing homes pursuant to the ACA.

MainStory: TopStory SNFNews IPPSNews CMSNews LTCHNews HealthReformNews QualityNews

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