Medicare is fining nursing homes when patients are readmitted too soon to hospitals

admitting-300x210Federal regulators have warned nursing homes nationwide to improve the quality and safety of their patient care or face consequences that operators may hasten to heed. That’s because new penalties and rewards will hit them in a place that counts — their pocketbooks.

Two-thirds of the nation’s nursing homes will see a year’s worth of their Medicare funding reduced, the nonprofit, nonpartisan Kaiser Health News Service (KHN) reported, “based on how often their residents ended up back in hospitals within 30 days of leaving.”

KHN said that:

Hospitalizations of nursing home residents, while decreasing in recent years, remain a problem, with nearly 11 percent of patients in 2016 being sent to hospitals for conditions that might have been averted with better medical oversight. [Uncle Sam’s new] bonuses and penalties are also intended to discourage nursing homes from discharging patients too quickly — something that is financially tempting as Medicare fully covers only the first 20 days of a stay and generally stops paying anything after 100 days.

Under the pertinent data, as analyzed by the health and medical news site, 85 percent of nursing homes in Arkansas, Louisiana and Mississippi will be penalized and lose money, while more than half in Alaska, Hawaii, and Washington state will get bonuses, KHN reported. In Maryland and the District of Columbia, the winner-loser split is almost equal, but in Virginia, just a third of nursing homes will be rewarded, while the other two-thirds will be penalized.

CMS has worked for years with nursing homes to develop standards and to see how facilities better can meet them — to residents’ benefits.  Hospitals for years have worked with regulators under similar readmission measures. They not only aim to improve direct care but also to encourage improvements in coordination of care, discharge processes, and patient follow-up. Safety advocates have supported readmission measures but have expressed concern that frail, infirm, and chronically ill seniors and their loved ones may face great hurdles in finding nursing homes that will care for them as a result.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage done to them and their loved ones by neglect and abuse in nursing homes. Our nation is graying, and researchers already say that more of us than had been believed likely will spend time in nursing homes — so it’s in the best interests of us all to ensure the access, affordability, safety, and quality of care in these important facilities.

In that vein, it’s also good to see that CMS officials say they have stepped up weekend and evening inspections of nursing homes, seeking to ensure appropriate staffing.

KHN, to its credit, caught regulators slumbering on the job: They had allowed nursing homes to self-report important figures on how many nurses, aides, and others were caring for patients. The agency then changed its rules, demanding that the staffing figures be backed up by payroll information. KHN crunched the numbers to find that too many nursing homes had given incorrect data to regulators, scrimping, instead, on paying appropriate numbers of caregivers.

This meant that on weekends and at nights, many nursing homes had skimpy caregiving personnel on deck. The homes argued this did not affect patients, because so many loved ones visited or tended to them during shortfall periods. Uncle Sam disagreed, cracked down, and, in many cases, punished nursing homes publicly and further by lowering their public and much-watched ratings.

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