Will CMS Add Hospitalization Rates to Nursing Home Quality Ratings and Surveys?

One out of every four Medicare nursing home residents was hospitalized in FY 2011, according to a recent study by the Health and Human Services Office of the Inspector General (OIG).According to OIG’s study, more than 825,000, or 24.8 percent of Medicare residents were hospitalized during FY 2011, costing Medicare $14.3 billion. On average, Medicare spent $11,255 every time a nursing home resident was hospitalized. That amount is about 33 percent higher than the average cost of hospitalizations for all Medicare beneficiaries. As a result of the rate of hospitalizations and associated costs, providers can expect the Centers for Medicare and Medicaid Services (CMS) to scrutinize this aspect of long-term care even more closely.

In addition to examining the rate of hospitalizations and related costs, OIG also looked at the specific medical conditions triggering hospitalizations; the extent to which the hospitalization rates varied according to the type of nursing facility making the hospital transfer; and whether the hospitalization rates correlated to specific nursing home characteristics, such as a facility’s rating on the CMS Five-Star Quality Rating System.

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