HHS OIG to audit for Potentially Preventable Hospitalizations from Care Centers

Posted on October 27, 2022 by LeadingAge

The Office of the Inspector General (OIG), a division of the US Department of Health and Human Services (HHS), announced an additional investigation as part of its 2022 work plan. Its added focus will be on whether skilled nursing facility residents were hospitalized with certain conditions and whether the facility provided services per the resident’s care plan and professional standards of practice.

OIG’s claim review shows that skilled nursing residents often present in hospitals with the following conditions: pneumonia, congestive heart failure, urinary tract infections (UTIs), dehydration, chronic obstructive pulmonary disease/asthma, and sepsis. According to previous Centers for Medicare and Medicaid Services (CMS) studies, five of the six conditions, not including sepsis, make up 78% of long-term care resident transfers to hospitals.

OIG states: “We will review inpatient hospitalizations of SNF residents with any of these six conditions and determine whether the SNF provided services to residents in accordance with their care plans and professional standards of practice (42 CFR § 483.21 and 42 CFR § 483.25).”

How to Prepare

In general, now is the time for care centers to ensure their audit readiness plans are in order, keep an eye on readmissions at their facilities, and to understand the rate of readmissions and related reasons for the readmissions. Some recommended ways to do this include:

• Examining your policies, procedures, and practices related to the identification of the six conditions identified by the OIG, including the content of care plans and implementation of care plans.
• Educating and training all staff on the detection, prevention, treatment, and care planning related to the six conditions, including awareness of the need to avoid preventable hospitalizations.
• Conducting a data analysis of trends related to the frequency and cause of inpatient hospitalizations and crafting a response plan to further examine any patterns noted.
• Using information from a data analysis or a random sample, conducting an audit (self-audit or with a third-party consultant) to examine how the facility is faring related to the detection, prevention, treatment, and care planning related to the six conditions.

More to Come

HHS OIG is expected to issue its report on the subject in 2024. Watch Advantage for further updates on this topic.