Industry News

The OIG Recommends Additional Monitoring for Medicare Nursing Home Hospitalization Rates.

Lisa Shuman | November 2013

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued a report analyzing Medicare nursing home residents who experienced hospitalizations in fiscal year (FY) 2011.  According to the OIG, nursing homes with high rates of hospitalizations may indicate quality problems within the nursing home.  The OIG report also notes that residents may experience harm during hospitalizations, including disruption of their care plans, disorientation, stress, and adverse events.

The OIG found that in FY 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions for a variety of conditions, most commonly for septicemia.  Overall, Medicare spent $14.3 billion on the nursing home hospitalizations.  The OIG also found that annual rates of Medicare resident hospitalizations varied across nursing homes.  However, nursing homes located in Arkansas, Louisiana, Mississippi, or Oklahoma and homes with one, two, or three stars according to the CMS Five-Star Quality Rating System had the highest annual rates of resident hospitalizations.  

The OIG made the following recommendations to which CMS concurred:

  • Create a quality measure that describes nursing home resident hospitalization rates and report the measure on the Nursing Home Compare Web site; and
  • Direct state survey agencies to review rates of hospitalization for nursing home residents as part of the survey and certification process and guide agencies on how to interpret and use the quality measure.

The OIG report on nursing home resident hospitalization rates is available at:

Department of Health and Human Services Office of Inspector General.  “Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring.”  19 Nov. 2013.  OEI-06-11-00040.  19 Nov. 2013.

About the Author

Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.