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Transcript for audio podcast: Nursing Home Resident Hospitalizations Merit Additional Monitoring

From the Office of Inspector General of Department of Health and Human Services

http://oig.hhs.gov

[Blaine Collins] I'm Blaine Collins with the Office of Inspector General, speaking with analyst Jeremy Moore, about the first report in a series examining how often nursing home residents are hospitalized. Jeremy, tell us why you did this work.

[Jeremy Moore] Thanks Blaine. We did this work because nursing homes provide critical healthcare to millions of Medicare patients. About 20 percent of all Medicare patients spend time in a nursing home in a given year. Sometimes nursing homes have to send these residents to hospitals for treatment. But moving a resident to a hospital can be disorienting for an older, fragile person. It may also increase the risk for adverse events in hospitals, for example, infections. These hospital stays can also be costly to Medicare, and the patient.

[Blaine Collins] What did you look at, specifically?

[Jeremy Moore] We measured how often nursing home residents went to the hospitals and the cost of these hospital stays.

[Blaine Collins] How'd you go about it and what did you find?

[Jeremy Moore] We reviewed national data over an entire year, to identify when nursing homes sent their residents to hospitals. Out of 3.3 million nursing home residents, twenty-five percent, or one quarter, were hospitalized at least one time, and many were hospitalized multiple times.

[Blaine Collins] So a quarter of Medicare nursing home residents were hospitalized. Did you also look at what's behind these hospitalizations?

[Jeremy Moore] We did. And they range from serious situations that required emergency care, to routine matters like pre-planned surgeries. The most frequent condition that led to a hospital stay was septicemia, which is a serious bloodstream infection that can quickly become life threatening. It accounted for 13 percent of all resident hospitalizations.

[Blaine Collins] And how much did these hospitalizations cost?

[Jeremy Moore] These hospitalizations cost the Medicare program just over $14 billion dollars in fiscal year 2011. The average hospital stay cost approximately $11,000 dollars. But here is something interesting: the $11,000 dollar cost was 33 percent higher than the average hospital cost for Medicare patients who did not come from a nursing home.

[Blaine Collins] Can you tell us anything about the nursing homes these patients came from?

[Jeremy Moore] Sure. Some nursing homes sent residents to hospitals far more often than other nursing homes. We found that nursing homes that sent patients to hospitals more often scored lower on the Medicare 5-Star rating system that is posted online at the Nursing Home Compare website. We think this information about nursing home hospitalization rates will be helpful to the healthcare community, patients and families because high hospitalization rates could signal quality of care problems with certain nursing homes.

[Blaine Collins] What other factors contributed to higher hospitalization rates?

These rates varied by geographic region, the size of the nursing home, and what type of entity owned the nursing home, for example, for-profit entities, non-profit groups, or government bodies.

[Blaine Collins] What are your recommendations?

[Jeremy Moore] We are concerned that some of these hospitalizations may be avoidable, and we are evaluating how often that is the case in a follow-up review. In the meantime, we recommend that the Centers for Medicare & Medicaid Services, known as CMS, develop a quality measure tracking how often each nursing home sends residents to the hospital. Nursing homes could use this measure to guide their quality improvement efforts, and CMS could consider making this information publically available on the "Nursing Home Compare" website, for residents and their families to see. We also recommend that CMS instruct nursing home inspectors to look at the hospitalization numbers when they evaluate nursing homes for quality.

[Blaine Collins] Give us a look ahead. What additional work does OIG plan in this area?

[Jeremy Moore] We're planning two reports. The first will evaluate how many of these hospitalizations were likely avoidable. Figuring out which of these hospital stays could be prevented will help us pinpoint where nursing homes need to improve. We will also release a report about how often adverse events, such as falls and bedsores, occur in nursing homes. Together, these reports will provide a better understanding of why nursing home residents are sent to hospitals so frequently, and help inform policies for reducing avoidable hospitalizations, and harm, to these vulnerable residents.

[Blaine Collins] Jeremy Moore, thank you for sharing this important work about nursing home care and I look forward to hearing more.

[Jeremy Moore] Thank you, Blaine.

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