Quality of care

OIG study recommends developing new quality measure

A new Office of the Inspector General (OIG) study has recommended to the Centers of Medicare & Medicaid Services (CMS) that they develop a quality measure that describes nursing home resident hospitalization rates.

The OIG study states:

Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care. Such transfers to hospitals provide residents with access to needed acute-care services. However, hospitalizations are costly to Medicare, and research indicates that transfers between settings increase the risk of residents’ experiencing harm and other negative care outcomes. High rates of hospitalizations by individual nursing homes could signal quality problems within those homes.

The OIG study found that in 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent $14.3 billion on these hospitalizations. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common. Annual rates of Medicare resident hospitalizations varied widely across nursing homes. Nursing homes with the following characteristics had the highest annual rates of resident hospitalizations: homes located in Arkansas, Louisiana, Mississippi, or Oklahoma and homes with one, two, or three stars in the CMS Five-Star Quality Rating System.

The OIG recommended to CMS:

  • Develop a quality measure that describes nursing home resident hospitalization rates
  • Instruct state survey agencies to review the proposed quality measure as part of the survey and certification process

In its comments on the draft report, CMS concurred with both of the recommendations.

To read the report in full, click here.