Medicare Cracks Down on Nursing Homes with High “Boomerang Hospitalization” Rates

According to the Kaiser Health News, an average of 21 percent of nursing home residents are readmitted to the hospital within 100 days of returning to their nursing home. Now, Medicare plans to crack down on these nursing homes who either allow nursing home residents to return too quickly or fail to properly administer the resident’s post-hospitalization care. According to Medicare, most nursing home patients are readmitted for mostly preventable problems, such as dehydration, bedsores, infections, and medication errors. While patient advocates believe there can be significant room for improvement in these re-hospitalization rates, they also caution against punishing nursing homes who send their elderly residents to the hospital.

According to a government report, cited by NPR, a full 10.8 percent of re-hospitalizations are preventable. The causes for the high rate of unnecessary hospitalizations are numerous. First, the nursing home may not follow the hospital’s post-hospitalization care routine for their resident. In one example cited by the news organization, nurses at a nursing home in North Carolina injected a patient with a blood thinner twice a day – despite written instructions from a hospital doctor to cease all blood thinning medication. The second cause concerns overloaded hospitals, which would prefer to offload patients onto nursing homes in an effort to free-up space for more patients.

The more disturbing cause, however, falls on Medicare’s payment program which incentivizes high hospitalization rates. Medicare, which is the insurance provider for most nursing home patients, incentivizes early discharge of their patients at hospitals. Further, the nursing home receives significant income from the lab tests, frequent examinations, and scans which are typically necessary when a resident returns to their nursing home after a hospitalization. In some states, nursing homes are even provided a “bed-hold” stipend, which effectively allows the nursing home to receive the same income as if the resident were still living in the facility. These “bed-hold” fees can extend for up to 100 days.

Patient and elder care advocates say there is significant room for improvement. A full one-fifth of nursing homes have an unnecessary readmission rate of less than five percent. Further, since Medicare began cracking down on the practice, the number of preventable re-hospitalizations has dropped from 12.4 percent in 2011 to 10.8 percent in 2016. These same advocates worry that Medicare must strike a delicate balance between lowering re-hospitalization rates, which harm patients, and discouraging necessary re-hospitalizations, which would also harm patients. With the high rate of avoidable hospitalizations, it is a balance Medicare will need to get right.

Contact the Law Offices of Thomas L. Gallivan, PLLC if you or a loved one has been a victim of nursing home neglect or abuse.

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