Kusserow on Compliance: OIG says 29% of rehab hospital patients experience harm, costing Medicare $100M per year

The HHS Office of Inspector General (OIG) issued a report on evaluation of care provided in rehabilitation (rehab) hospitals, post-acute providers that specialize in intensive rehabilitative care for patients recovering from illness, injury, or surgery.  The OIG noted that while considerable attention in recent years has been paid to patient safety in acute-care hospitals and increasingly in skilled nursing facilities (SNFs), less is known about adverse events in other health care settings. An increased understanding of adverse events that occur in this unique setting would better equip health care providers and other stakeholders in taking actions to improve the safety of patient care in rehab hospitals.

What the OIG found was an estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehab hospital stays, resulting in temporary harm; prolonged stays or transfers to other hospitals; permanent harm; life-sustaining intervention; or death.  This harm rate is in line with what the OIG has reported in the past for hospitals (27 percent) and in SNFs (33 percent). Physician reviewers determined that 46 percent of these adverse and temporary harm events were clearly or likely preventable and much of that was as result of substandard treatment, inadequate patient monitoring, and failure to provide needed treatment. Among the documented preventable incidents of harm were bedsores, medication errors and infections. Study data has suggested medical errors are the third-leading cause of death in the U.S., claiming as many as 250,000 lives a year. However, many disagree with those figures.  Nearly one-quarter of the patients who experienced adverse or temporary harm events had to be transferred to an acute-care hospital for treatment.

To come up with their findings, the OIG reviewed a nationally representative sample of 417 Medicare beneficiaries discharged from rehab hospitals during one month to estimate the national incidence rate, preventability, and costs of adverse events in rehab hospitals.  As result of their study, the OIG recommended:

  • Results of the current study taken with others performed for acute-care hospitals and SNFs confirm the need and opportunity to significantly reduce the incidence of adverse events across health care settings.
  • AHRQ and CMS raise awareness of patient safety issues in rehab hospitals and seek to reduce patient harm. This effort should include: (1) collaboration to create and disseminate a list of potential adverse events that occur in rehab hospitals and (2) the addition of information about potential adverse events in quality guidance to rehab hospitals. CMS and AHRQ concurred with our recommendations.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2016 Strategic Management Services, LLC. Published with permission.