Nov. 19—Nursing homes transferred one-quarter of their Medicare patients to hospitals for inpatient care in 2011, according to a government watchdog.

The U.S. Health and Human Services Department’s Office of the Inspector General (OIG) found Medicare spent $14.3 billion on the more than 825,000 beneficiaries transferred from nursing homes to inpatient hospital settings. Transferring facilities included skilled nursing and rehabilitative facilities and long-term care centers.

The highest annual rates of resident hospitalizations occurred in nursing homes in Arkansas, Louisiana, Mississippi, and Oklahoma. High admissions also were clustered among facilities with one though three stars under the Centers for Medicare & Medicaid Services’ (CMS’s) Five-Star Quality Rating System.

Annual hospitalization rates ranged from 1 percent to nearly 70 percent of a nursing home’s residents. The OIG found that 1,059 nursing homes (7 percent) had annual hospitalization rates greater than 40 percent.

Although Medicare beneficiaries were admitted for a range of conditions, septicemia was the most common diagnosis. That diagnosis drove 13 percent of hospitalizations and 21 percent of Medicare spending on nursing home resident inpatient care.

The analysis found the average hospital stay cost about $11,000, which was 33 percent more than the average hospital cost for all Medicare patients.

High rates of hospital admissions are costly to Medicare, the OIG report noted, and raise concerns increased risk of complications for beneficiaries and nursing home quality problems.

“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,” Jeremy Moore, an OIG analyst, said in a podcast about the report.

In response to the findings, CMS plans to develop a quality measure for nursing home resident hospitalization rates. Additionally, the agency plans to instruct inspectors to review the proposed quality measure as part of the survey and certification process.

Publication Date: Tuesday, November 19, 2013