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Avoidable Admissions: Keeping Nursing Home Residents out of the Hospital

Garcia & Artigliere

Unnecessary hospitalizations aren’t just expensive. They’re a form of theft, taking scarce resources away from patients who need them. Thanks to a recent effort by Medicare and Medicaid, however, nursing homes must finally get serious about reducing avoidable admissions.

Superfluous Spending
Roughly 45% of Medicare or Medicaid subscribers who are hospitalized could have been treated outside of the hospital. This amounts to 314,000 patients per year, causing Medicare to spend $2.6 billion more than it otherwise would have. Because caregivers can externalize patients’ health problems in hospitals, they have little incentive to address abuse and patient safety issues in nursing homes.

Unnecessary hospital admissions are the result of caregivers’ poor training and neglect, combined with the fear that they will be sued if they don’t hospitalize a patient and something goes wrong. The payment structure of Medicare and Medicaid also encourages hospitalization. Nursing homes receive $600 a day for 100 days after they admit patients who have been hospitalized for three days, compared to only $150 per day for patients who have been in their care for long periods of time. If a nursing home keeps a patient’s bed empty, Medicare and Medicaid will compensate it even while the patient is still in the hospital.

Sustainable Solutions
The Medicare-Medicaid Coordination Office has recently launched an effort to discourage nursing homes from hospitalizing their patients without good reason. The Office tracks all facilities’ hospital admissions and their reasons for doing so. The more often a nursing home sends its patients to a hospital, the less likely Medicare and Medicaid are to discharge patients back to that facility.

In reducing hospital admissions, Medicare and Medicaid do not want to compromise patient care, which is why this initiative also involves training and equipping nursing homes to deal with their own patients’ illnesses. This involves installing health IT systems, improving communication with hospitals, and paying nurses and doctors who work at nursing homes the same as those who work in hospitals. Not only will this lower spending, but by providing faster care, it will improve health outcomes and reduce patient safety issues in nursing homes.

As an experienced nursing home abuse attorney, Garcia, Artigliere, & Medby is committed to reducing unnecessary spending and patient safety issues in nursing homes. To secure quality care for your friends and loved ones, visit our website today.


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