The recent Forbes article entitled "Obama cracks down on nursing home quality,"says changes to Medicare put forth by the administration’s deficit reduction plan may impose cuts in funding to skilled nursing facilities whose patients are sent to the hospital too many times. A little noticed provision in the plan would penalize nursing homes for sending patients to the hospital when they lack the staff to care for patients or have caused the patient to be admitted.
For nursing homes whose patients are sent to the hospital frequently, financial penalties may be in the offing, especially if patients are admitted to the hospital due to causes which could have been avoided, including falls, infections or poor medication management. In addition, as part of the broad deficit reduction plan, the plan would cut more than $300 billion from projected Medicare and Medicaid spending, including cuts in general payments to nursing homes, home health agencies, other providers, and drug companies.
While this plan may not play too well in Peoria, the Henry J. Kaiser Family Foundation, the non-profit, private operating foundation focused on major health care issues facing the U.S., appears to back the plan saying, "[a]n estimated 40 percent of nursing facility residents are admitted to the hospital in a typical year, and one-quarter of these may be preventable." This may be true, but "one-quarter" of them being preventable does not seem like a high enough percentage to justify this provision of the proposed legislation. Congress should be careful – on all issues – to not throw out the baby with the bath water.
While the causes (of sending patients to the hospital too frequently) may often be preventable and nursing homes might be penalized financially for doing so, it does not mean that nursing home patients will be admitted to hospitals any less frequently. States’ nursing home regulations are often the driving factors in who goes to the hospital, why and when. Ensuring that federal and state regulations (which determine who goes to the hospital, why and when) remain consistent would seem to be the first course of action. Sadly, for the patients, there is always the possibility that in order to satisfy federal requirements of admitting patients less frequently, nursing homes might do a "work-around" and some patients who may need to go to the hospital would not be sent, or the actual reasons for sending a patient could even become obfuscated, by less-than-ethical nursing homes. Perhaps before the deficit reduction plan cracks down on skilled nursing facilities, its authors and law-makers might re-examine relevant regulations governing who goes to the hospital, why and when.