After reviewing 140 cases, the HHS inspector generals office reports that quality-of-care problems such as medical errors, accidents and other woes were associated with some 35% of so-called consecutive stays, in which a Medicare beneficiary has three or more inpatient and skilled-nursing facility stays in which each successive stay started within a day of the preceding stays discharge date.
In addition, such lapses in quality cost the federal government $4.5 billion, according to 2004 data on consecutive stays.
Physician reviewers for the inspector generals office found that 20% of individual stays lacked sufficient documentation to allow them to determine whether or not the admission, treatment and discharge were appropriate.
The findings mirror a 2005 report that looked at consecutive Medicare inpatient stays only. In a list of four recommendations, the inspector generals office said that the CMS should direct its network of quality improvement organizations to monitor consecutive-stay sequences; encourage QIOs and fiscal intermediaries to monitor the medical necessity and appropriateness of services; collaborate with providers to improve systems of care; and reiterate to providers that they need to fully document a stay in order to receive Medicare reimbursement. -- by Matthew DoBias