Nearly one out of three Medicare beneficiaries discharged from rehabilitation hospitals in March 2012 were medically harmed during stays at the facilities, according to a report released Wednesday by HHS' Office of Inspector General.
About 46% of the incidents were preventable, according to the OIG.
Attempts to reach the American Medical Rehabilitation Providers Association for comment were not immediately successful. But the OIG's latest findings for rehab hospitals are actually in line with harm rates at acute-care hospitals and skilled nursing facilities, according to the OIG.
In 2010, OIG found that 27% of hospitalized Medicare beneficiaries experienced adverse events or temporary harm during their time at the hospitals. And in 2014, the OIG found that 33% of Medicare residents in post-acute Skilled Nursing Facilities fell victim to the same issues.
According to the report, the OIG's latest finding “confirms the need and opportunity to significantly reduce the incidence of adverse events in rehab hospitals, thereby improving the quality of care that patients receive.”
The similar rates of adverse events and harm at rehab facilities, acute-care hospitals and skilled-nursing facilities shows that research and interventions to reduce such problems may apply across all three types of care providers, according to OIG.
In this latest report, OIG analyzed a sample of 417 Medicare beneficiaries discharged in March 2012, and of those, 158 experienced adverse events or temporary harm during their stays.
“It's really clear that is a really large problem,” said Caitlin Donovan, director of outreach and public affairs for the National Patient Advocate Foundation. Between this report and a recent analysis published in the BMJ that showed medical error kills more than 250,000 Americans each year, “we need to take a close look at what we can do to help improve the patient mortality rate and the patient experience,” Donovan said.
She cautioned, however, that rather than condemning the healthcare professionals who work in rehab and other facilities, such workers must be given the support and structure they need to do their jobs well.
OIG found that 18% of patients in the sample experienced temporary harm that required intervention. Another 8% experienced an adverse event that led to a longer stay in a rehab hospital or transfer to an acute-care hospital for observation, emergency treatment or inpatient care. Nearly 2% experienced an adverse event that required life-sustaining intervention. Fewer than 1% of patients were permanently harmed, and fewer than 1% of patients died.
Medication-related issues (such a bad reaction to a medication) and issues related to care (such as a fall or bed sore) were the most common causes of harm, and infections were the lowest.
Substandard treatment and failure to adequately track a patient's progress were the most frequently cited factors in the instances of preventable harm. In one case, for example, an elderly patient admitted to a rehab hospital after a stroke and a recent diagnosis of hypertension was weak and walked unsteadily because of an overly aggressive and poorly monitored use of a medication. Those symptoms resolved after the rehab hospital reduced the patient's dosage of the medication.
Based on its findings, OIG estimates that 7% of all Medicare beneficiaries who were discharged from rehab hospitals in March 2012 went to an acute-care hospital for treatment because of harm sustained at a rehab hospital at a cost of $7.7 million. If that rate were to stay steady throughout the year, Medicare would spend $92 million annually on acute-care hospital admissions and emergency department visits for patients harmed at rehab hospitals.
OIG recommends in the report that the CMS and the Agency for Healthcare Research and Quality raise awareness of harm in rehab hospitals by creating and promoting a list of potential incidents. OIG notes that the two agencies have already been working together on such a list of potentially reportable events in acute-care hospitals and skilled nursing facilities.
OIG also recommends the CMS include more information about potential harm in its quality guidance to rehab hospitals. That guidance should include a definition of “adverse events,” a list of potential events to educate staff, and strategies for finding and preventing adverse events.
The Agency for Healthcare Research and Quality and the CMS agreed with the recommendations.
