But the CMS says it is already moving to beef up inspection efforts at nursing homes with quality-of-care problems, based on a 2005 finding that as many as 314,000 hospital admissions could have been prevented among Medicare and Medicaid nursing home residents.
Sepsis is a fast-moving infection that often begins in the skin, lungs or abdomen and then spreads to the bloodstream. Older patients who become septic are in grave danger. A review of national data by the Centers for Disease Control and Prevention published in 2011 found that patients age 65 and older died 20% of the time when hospitalized for sepsis, compared with a 3% death rate for all other hospitalizations in that cohort.
The OIG report released on Nov. 19 looked broadly at how often the 3.3 million Medicare beneficiaries living in nursing homes ended up in the hospital and found that in 2011, a quarter of them did. Nursing home residents' hospital care cost $14.3 billion that year.
But those costs are not spread evenly. Nursing homes ranked at one, two, or three stars on the CMS' five-star quality rating system were more likely to transfer residents to hospitals, as were facilities in Louisiana (39% of residents hospitalized), Mississippi (36%), Arkansas and Oklahoma (32% each).
“Higher-than-average resident hospitalization rates of some nursing homes in fiscal year 2011 suggest that some hospitalizations could have been avoided through better nursing home care,” according to the report.
The biggest reason hospitals received quality rankings of three or fewer stars was because of low marks for inadequate staffing.
CMS Administrator Marilyn Tavenner said the Medicare agency has been actively addressing the issue.
In response to the OIG report, she highlighted a CMS demonstration program launched in 2012 to reduce preventable hospitalizations among nursing home residents. Seven organizations have been chosen to implement hospitalization-prevention efforts in 15 nursing homes each, and the effort is ongoing.
Tavenner also noted the CMS has already proposed new quality measures for hospitalization rates at nursing homes and skilled-nursing facilities, which could be used by the public and state surveyors to judge the quality or care in a particular facility.
“Nursing home quality measurement and oversight is of critical importance to us, including addressing unnecessary hospital admissions and readmissions,” Tavenner wrote in her response letter to the OIG report.
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