The Department of Health and Human Services’ (HHS) watchdog arm added a probe of skilled nursing residents who had potentially preventable hospitalizations in its list of priorities over the next year.
The HHS Office of the Inspector General (OIG) recently announced an additional investigation as part of its 2022 work plan — specifically focusing its efforts on if SNF residents were hospitalized with certain conditions and whether the facility provided services in accordance with the resident’s care plan and professional standards of practice.
OIG’s claim review shows that skilled nursing residents often present with the following conditions: pneumonia, congestive heart failure, urinary tract infections (UTIs), dehydration, chronic obstructive pulmonary disease/asthma and sepsis.
Five of the six conditions — not including sepsis — make up 78% of the long-term care resident transfers to hospitals, according to previous Centers for Medicare & Medicaid Services (CMS) studies.
The work plan, updated monthly to identify high-risk areas to undertake audits and evaluations, is set to be published some time in 2024, according to OIG.
OIG announced the addition of another investigation to its docket back in August, this one involving whether skilled nursing facilities are reporting related-party costs in accordance with federal regulations.
The agency will also look into whether Medicare reimbursement is sufficient to cover beneficiary care – particularly if overhead costs have increased while allocations for patient care decreased.
“Understanding skilled nursing facilities’ (SNFs’) costs is crucial to understanding the factors that contribute to nursing home performance and how nursing homes deliver care to beneficiaries,” OIG noted in its work plan.
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