Transcript for the audio podcast:
Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements
From the Office of Inspector General of Department of Health and Human Services
[Sheila Nair] I'm Sheila Nair, Public Affairs Specialist, speaking with Judy Kellis, a Team Leader for the Office of Evaluation and Inspections in New York. And, we're talking about the report called Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements. So can you tell me, Judy, about Medicare's skilled nursing facilities?
[Judy Kellis] Sure. Skilled nursing facilities are nursing homes that provide skilled care to Medicare patients. This can be nursing care, therapy, and other services, like assistance with eating or bathing. Last year, Medicare paid for services for nearly 2 million patients.
[Sheila Nair] How does Medicare make sure that nursing facilities provide good care to patients?
[Judy Kellis] Facilities have a duty to provide good care. They are required to evaluate each patient's needs and develop a care plan specifically for that patient.
[Sheila Nair] Judy, why are these care plans so important?
[Judy Kellis] The care plan is a guide to everyone who provides care to the patient. Care plans identify problems and set specific treatment goals. They help ensure that everyone caring for the patient is on the same page. Facilities must then provide the services that they've outlined in the plans.
[Sheila Nair] Are nursing facilities meeting their obligations?
[Judy Kellis] Unfortunately, no. Many facilities are not developing proper plans AND they are not providing adequate care. In 15 percent of stays, facilities didn't provide the care the patient needed.
[Sheila Nair] It sounds like some patients aren't getting the help they need.
[Judy Kellis] That's right. We found that in one out of five stays, patients had problems that weren't even addressed. In one case, the facility didn't have any plans to monitor the drugs a patient was on, even though those drugs could have serious side effects.
In other cases, facilities were doing too much, as opposed to too little.
[Sheila Nair] How could a nursing facility do too much?
[Judy Kellis] By providing unnecessary services that offer no benefit to the patient, and could actually cause harm. We have seen this with therapy services because facilities have a financial incentive to provide more therapy than a patient needs. The more therapy a facility provides, the more they are paid.
[Sheila Nair] Can you give us an example?
[Judy Kellis] Sure. In one case, a facility provided intense physical therapy to a patient with terminal lung cancer. The patient didn't want it, but the therapy continued 5 days a week for 5 weeks. In another case, a patient received hours and hours of high-level physical therapy, even though she had a dislocated hip and should not have been moving.
[Sheila Nair] What about when the patient leaves a nursing facility, are there any concerns at that point?
[Judy Kellis] A smooth transition to the next care setting is essential to a patient's safety and well-being. That's why the nursing facility must provide information and instructions for each patient's future care.
[Sheila Nair] Are nursing facilities doing this?
[Judy Kellis] Well, in a third of cases, facilities didn't provide enough information when the patient moved to another setting. This can be dangerous because many patients have complex conditions and they often take many medications. It can also lead to unnecessary hospitalizations, which are not only expensive, but obviously bad for the patient.
[Sheila Nair] We've talked about problems with care planning, providing services, and handling transitions. So, how many Medicare dollars are involved?
[Judy Kellis] It's quite a lot. In 2009, Medicare paid $5.1 billion to facilities when they did not plan properly, provide adequate care, or promote good transitions for patients. This raises questions as to what Medicare is really paying for.
[Sheila Nair] What are you recommending that the Centers for Medicare and Medicaid Services, or CMS, the agency responsible for Medicare, do about these problems?
[Judy Kellis] The way Medicare pays nursing facilities right now offers few incentives to provide high quality care. Medicare should use its purchasing power to ensure that facilities provide good care and transitions for patients. That said, CMS needs to link payment to quality. CMS should pay for good performance and better outcomes as opposed to the volume of services provided. That way, patients get better care and overall health care costs can go down.
[Sheila Nair] Judy Kellis, with the Office of Evaluation and Inspections, thank you so much for sharing this important work.
[Judy Kellis] Thank you.
Let's start by choosing a topic
Priority recommendations summarized.
OIG planned projects.
Significant OIG activities in 6-month increments.