Out of thousands of skilled nursing (SNF) facilities across the country, Medicare spent nearly $ 28 billion in 2019 on acute care for 1.5 million beneficiaries, but in a study released this week, The US Government Accountability Office says readmission rates at SNF hospitals are higher than they should be due to staffing issues.
He noted that stronger financial incentives to provide better care would help.
GAO analyzed CMS staffing and critical incident data, Care Compare and Medicare claims data information for 2018 and 2019, and interviewed officials from the Centers for Medicare and Medicaid Services (CMS) and ‘other stakeholders for the study.
According to the GAO study, Medicare spent about $ 5 billion in 2018 on critical incidents that the CMS defines as potentially preventable, with 377,000 hospital readmissions within 30 days of SNF admission.
Without stronger payment incentives, Medicare is unlikely to reduce the billions spent on potentially preventable critical incidents or the harm to patients that can result from them, GAO argued.
The office recommends that the Department of Health and Human Services implement appropriate payment reductions for NFCs spending Medicare dollars on potentially preventable critical incidents – hospital readmissions and emergency room visits that occur in 30 days following SNF admissions.
Purchasing programs based on the value of SNFs have been suggested as possible solutions to better incentivize SNFs and avoid preventable critical incidents.
According to GAO, cuts of up to 2% in some SNF payments that CMS is implementing to incent operators to improve care do not apply to the additional cuts.
“Experts noted that payment incentives under current law may not be sufficient to motivate NFCs to improve their staff, which in turn could lead to a reduction in critical incidents,” argued researchers from study.
While almost all SNFs, 99%, were found to meet the federal requirement for an on-site registered nurse with eight hours per day, less than a quarter met the minimum and total nursing staffing thresholds in nurses that CMS identified as needed to avoid quality issues, the study showed.
The average number of RN staff hours has also been shown to decrease by around 40% on weekends, limiting the ability of beneficiaries to make informed choices among NFS when choosing a facility.