A report released last month by the Office of Inspector General found that about one-third of skilled nursing facilities chosen from a random sample were not meeting some of the requirements for Medicare funding.
The Centers for Medicare & Medicaid Services mandates that skilled nursing facilities, or nursing homes, create care and discharge plans for every patient. These plans are meant to ensure that patients receive quality care in the facility and transition safely to other settings.
The report's authors performed medical record reviews of patients treated longer than 21 days at nursing homes across the country in 2009. What they found was that 37 percent either did not develop care plans or provide services from those plans; 31 percent did not meet discharge planning requirements; 19 percent did not address at least one of the patients' problems; and 15 percent did not provide services for the length of time called for in the care plans.
These plans are an important part of care provided in nursing homes, said Rhonda Richards, senior legislative representative for AARP.
"Those are important points in the process to really assess the residents' needs and to involve the family caregiver," she said. "At discharge, it is critical that providers who will care for patients as well as family members, have information for a smooth transition."
Don White, spokesperson for the OIG Office of External Affairs, said the report was part of a larger look at nursing homes. The OIG was studying skilled nursing cost issues and, in the process, found a high percentage did not have the required plans, which prompted this study.
OIG recommended that CMS strengthen care and discharge planning requirements including holding nursing homes more accountable for planning requirements and linking Medicare payments to meeting these requirements.
"The OIG can only make recommendations," White said. "And OIG reports jointly to Health and Human Services and Congress and it is our hope that these findings will be of interest to folks on the Senate Special Committee on Aging, for example."
It's in CMS' interest to ensure that nursing home patients receive high-quality care. According to the report, Medicare paid $32.3 billion for skilled nursing services in the 2012 fiscal year. The report authors estimated that Medicare paid $4.5 billion for the stays where care plans were not developed or patients were not treated according to the plans.
"Our approach to these reports has historically been to find ways to collaborate and address problems," said Greg Crist, spokesperson for the American Health Care Association, a nursing home trade group. "If there are better ways, we want to adopt them. But (the findings in) this report doesn't necessarily mean that inadequate care was provided."
Crist said there were a few issues with the study. First, that there are 1.5 million people in nursing homes and the report looked at only 190 visits. Also, he said there are other ways to manage patients like "stand-up meetings" to discuss residents.
"There is a much larger picture there," he said. "We create (plans) but patients change and if they don't match all of the time, it would be called a violation. We would call it good medicine as they adapt to changes in a person's health."