In 2014, the Department of Health and Human Services (DHHS) released a 69-page report titled: “Adverse Events in Skilled Nursing Facilities: National Incidence Among Medicare Beneficiaries.” The DHHS noted that the Medicare expenditures for skilled nursing facilities is the second highest cost to the program, eclipsed only by hospital inpatient costs. To reduce costs, the DHHS hoped to identify issues with skilled nursing facilities, as it had previously done with hospitals. It’s recognized that injuries and illnesses lengthen the stays of patients in all health care facilities, including hospitals and nursing homes. The DHHS found:
An estimated 22 percent of Medicare beneficiaries experienced adverse events during the [skilled nursing facility] stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their [skilled nursing facility] stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care…
The DHHS found that the adverse events identified resulted in 79 percent more patients having longer stays or transfers to more acute facilities, 14 percent of those patients required some sort of intervention to save their lives, and 6 percent of those patients lost their lives as a result of an unintended adverse event.
The preventable harm caused to patients of nursing home and related facilities likely increased costs to Medicare by as much as $2.8 billion for hospital readmissions and treatment for fiscal year 2011 alone! Put in further context, in 2000, Medicare paid $12 billion toward patient care in skilled nursing facilities. By 2010, that number had increased to $26 billion. In 2011, Medicare paid $28.4 billion for 1.8 million Medicare recipients.
The study focused on the largest group of nursing home admissions – those who were admitted to a nursing home for 35 days or less, which constitutes 70 percent of all “Medicare beneficiary stays in skilled nursing facilities.” The DHHS took a random sampling of these patients to compile the information in its detailed report.
What this means, logically, is that the numbers referenced above are probably significantly higher than what the DHHS determined. As staggering as that seems, we have to remember that we are talking here more about people than dollars. Nevertheless, the costs to Medicare cannot be ignored.
The DHHS reviewed a number of potential “adverse events.” Some of the more common issues include medication errors, injuries during transfers from the hospitals to the skilled nursing facilities, falls, bedsores, and the like. The large categories of adverse events were further broken down by medication events (37 percent), events related to ongoing resident care (37 percent), and events related to infections (26 percent).
The DHHS recommended a variety of potential ways to identify and remedy the large number of patient care injuries. Nursing homes are already required to self-report, but the accuracy of this process is not known. Hopefully, one measure that will be implemented will be some sort of punishment mechanism, much like that which is already being done for overmedicating patients. However, according to an investigation conducted by the National Public Radio (NPR), few nursing homes are punished even where this practice exists.
The good news is that at least issues are being identified. Hopefully, as the American population grows, these measures by the DHHS and others will help to educate, train, and adequately staff nursing and medical personnel at nursing homes. As the old saying goes, “Prevention is worth a pound of cure.”
If you need more information on this subject, contact Ben Locklar, a lawyer in our firm who handles Nursing Home litigation, at 800-898-2034 or 334-269-2343, or by email at Ben.Locklar@beasleyallen.com. Ben is our firm’s lead lawyer in nursing home litigation.
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