• Adverse Events In Skilled Nursing Facilities

    Wednesday July 23, 2014



    The Office of the Inspector General recently released their findings of a study they conducted from 2009-2011. In this study they found an estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care. Over half of the residents who experienced harm returned to a hospital for treatment, with an estimated cost to Medicare of $208 million in August 2011.

    Because many of the events that were identified were preventable, their study confirms the need and opportunity for SNFs to significantly reduce the incidence of resident harm events.
    Therefore, the OIG recommended that the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS) raise awareness of nursing home safety and seek to reduce resident harm through methods used to promote hospital safety efforts. This would include collaborating to create and promote a list of potential nursing home events-including events that were found that are not commonly associated with SNF care-to help nursing home staff better recognize harm. The OIG stated that CMS should also instruct State agency surveyors to review nursing home practices for identifying and reducing
    adverse events. AHRQ and CMS concurred with our recommendations.

    Adverse Events in Skilled Nursing Facilities

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