As predictable as an episode of "I Love Lucy", this past week saw many reactions to the just published report issued by the Office of Inspector General at HHS on “Adverse Events in Skilled Nursing Facilities.” By now, the media mill has chewed through the report and spat out the juicy bits (here), while a sundry of advocacy groups piled on their own analyses and proposed remedies to the data presented in the report. Of course, this is much ado about something, the report's conclusions demand attention, but the headlines are meaningless without considering that beyond them are the facility staff and the federal and state regulators who work within a system designed explicitly to furnish to those living in skilled nursing facilities (SNF) the necessary services, “to attain or maintain the resident’s highest practicable physical, mental and psychosocial well-being.” The existing Medicare and Medicaid Requirements for Long-Term Care Facilities and its concomitant interpretive guidelines are voluminous and exhaustive. Compliance with these regulations is mandatory for SNFs to qualify for federal reimbursement under the Medicare and Medicaid programs and since those two programs reimburse for over eighty percent of the services provided in skilled settings, their impact on the delivery of services in SNFs cannot be overstated.
Building upon a 2012 study the OIG conducted on hospital adverse events this 65-page report applies a similar methodology to the skilled nursing setting and draws similar conclusions. For purposes of both reports an adverse event includes not only medical errors but may also include more general substandard care. However, adverse events do not always involve error or negligence and are not always preventable.
Broadly, the report found that:
- Twenty-two percent of Medicare beneficiaries experienced adverse events during their SNF stays, resulting in a prolonged stay or hospitalization, permanent harm, life sustaining-intervention, or death.
- Eleven percent experienced a temporary harm event
- This 32 percent total harm rate is similar to what OIG found in its 2010 hospital report!
- Fifty-nine percent of events were preventable.
In my next post, I'll continue by sharing some of the more thoughtful reactions to the report's findings as well my thoughts about where we should go from here. With parents who are members of the World War II generation (one of whom received PAC services in a skilled setting a few years ago), the issue of avoiding preventable adverse events in the skilled nursing setting is very close to my heart. What are your thoughts on this subject?
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