“There’s this saying in nursing homes, and it’s really unfortunate: ‘When in doubt, ship them out.’ ” -David Grabowski, PhD, Professor of health policy at Harvard Medical School
Amid findings that 1 in 5 Medicare beneficiaries who go to a nursing home following a hospital visit return within 30 days, the government is finally addressing high hospital readmission rates after a nursing home transfer. Beginning this October, the Centers for Medicare and Medicaid Services (CMS) will start handing out bonuses or penalties to nursing homes based on their hospital readmission rates.
If this concept sounds familiar, that’s because it is. In 2012, CMS implemented a similar policy, the Hospital Readmissions Reduction Program (HRRP), for hospitals, rewarding or penalizing them based on their 30 day patient readmission rate. Due to the influence of this policy, hospital readmission rates for Medicare recipients has already begun dropping, albeit not by much. The readmission rate fell just over 1.5 percent in 5 years. The latest numbers from 2016 show a Medicare readmission rate of 10.8%.
Many ask why a hospital would discharge a patient if they’re not actually ready to leave. Blame it on a flawed system. Medicare reimburses hospitals at a predetermined rate based on typical treatment time and procedures required by prior patients with the same illness. So the fewer days a Medicare recipient is occupying a bed, the more profit the hospital sees.
Hospitalizing Residents Saves Nursing Homes Money
While an abundance of caution is certainly not a bad thing, oftentimes the reasons for transferring nursing home residents to the hospital is less about concern for a resident and more about saving money. How does pushing a nursing home resident into the hospital benefit a nursing home?
- Keeping a resident at the nursing home while they’re ill requires competent medical care and more hands-on time, both of which nursing homes are well-known for skimping on.
- An illness usually requires costly tests, medications and procedures, another worrisome issue for nursing homes given that Medicaid reimburses them for these things at a low rate.
- Nursing homes also want to avoid any potential liability for not sending an ill resident to the hospital at the first sign of sickness. Many families also want their elderly loved one to be overseen in a hospital when they are sick.
- Residents who are sent back from a hospital are often given up to 100 days of nursing home care under Medicare. Medicare reimburses at a significantly higher rate than Medicaid, so much so that a large number of nursing homes are guilty of kicking out Medicaid residents to make room for incoming Medicare residents.
Reducing the number of nursing home residents who are repeatedly in and out of the hospital already seems to be becoming a reality. But nursing home resident advocates worry that CMS’ new policy might backfire. The fear is that nursing home owners and administrators might encourage staff to attempt to treat conditions that are beyond their capabilities in order to earn bonuses and avoid penalties. The Chicago nursing home abuse and neglect attorneys have successfully handled hundreds of cases in which residents were left to suffer in shockingly bad condition. In most of these instances, staff failed to prevent or properly treat illnesses, pressure sores, or notify a physician and/or family member of a change in health. Cutting down on repeat admissions may encourage nursing homes to take better care of residents, but it may just encourage them to attempt to treat injuries and illnesses for which they have little knowledge, training, or skills.
Readmissions Can Be a Red Flag
If someone you love has been subjected to poor treatment in a nursing home, including avoidable hospital readmissions, let our attorneys help you demand answers and justice. Consultations are free and can be requested by phone at (312) 332-2872 or by completing our online case evaluation form.