OIG Increases Scrutiny of Hospital Readmissions

Hospital readmissions take on more scrutiny as a core quality metric by the Health and Human Services Office of the Inspector General (OIG) as it looks closely at “possibly preventable” transfers of skilled nursing facility (SNF) residents. An expanded audit is part of the OIG’s growing oversight of unnecessary hospitalizations among Medicare-eligible skilled nursing residents.

Taken all together, financial incentives, penalties, and increased audit activity reflect a concerted federal policy initiative to reduce rehospitalizations. Specifically, OIG is exploring whether SNFs could have done more to prevent these conditions and the subsequent hospital readmission. With audits looming, SNF should get their audit readiness plans in order.

In the past, OIG focused on transfers to hospitals of patients with urinary tract infections (UTIs), a condition that is often preventable and treatable in a SNF without requiring hospitalization.  However, OIG will now review hospitalizations of SNF residents with any of the five conditions that account for 78% of transfers — pneumonia, congestive heart failure, UTIs, dehydration, and chronic obstructive pulmonary disease/asthma. The OIG will also include sepsis as it is preventable if the underlying cause is preventable.

The nation’s worst performing nursing homes regarding hospital readmission are already docked financially. Since 2018, SNFs entire Value-Based Purchasing program has been built around readmission performance. 

A JAMA study last year found that just 52 skilled nursing facilities of nearly 15,000 were able to improve enough from a poor baseline score to avoid a financial penalty, despite large reductions in readmission rates. Additionally, nearly one-quarter of those admitted to SNFs are readmitted to a hospital within 30 days, and those readmissions are associated with a quadrupled mortality rate within six months.

Read more here or download a tip sheet, Addressing OIG’s Increasing Scrutiny of Hospital Readmissions.