Medicare: Further Reporting on Essential Staffing Information and facts and Stronger Payment Incentives Required for Expert Nursing Facilities

Table of Contents What GAO LocatedWhy GAO Did This Research What GAO Located Medicare covers…

What GAO Located

Medicare covers quick-phrase treatment for inhabitants in about 15,500 skilled nursing amenities (SNF) soon after a hospital continue to be. GAO’s evaluation of 2019 staffing data uncovered that just about all SNFs routinely fulfilled a federal requirement for a registered nurse (RN) on site for 8 hours for every working day. Less SNFs frequently achieved two other staffing measures that specify distinct figures of nursing several hours for every resident per working day. For example, about half of SNFs often satisfied Centers for Medicare & Medicaid Services (CMS) circumstance-mix measures—hours worked for each resident that vary primarily based on the professional medical requires of every single SNF’s residents—that CMS makes use of to set SNF staffing ratings. Additional, about 1-quarter of SNFs often achieved staffing thresholds for minimal RN and full nurse staffing that a CMS staffing examine discovered as required to stay away from quality challenges. SNFs are not issue to these good quality thresholds for rankings or as requirements, but several stakeholders have suggested that they be employed as SNF staffing thresholds.

% of Proficient Nursing Facilities (SNFs) That Satisfied Registered (RN) Nurse Staffing Need or Steps, 2019

CMS studies sure critical staffing information—such as RN all round staffing hours—on its Treatment Review website, but does not report other significant info. For illustration, GAO found that typical RN staffing hours diminished about 40 % on weekends, but CMS does not specifically report this details. This restrictions the capacity of beneficiaries to make informed decisions amongst SNFs when selecting a facility.

GAO believed that in 2018 Medicare put in about $5 billion on significant incidents that CMS defines as most likely preventable—which are primarily about 377,000 hospital readmissions happening in just 30 days of the SNF admission. Present legislation directs CMS to make reductions of up to 2 per cent to selected SNFs’ payments to incentivize them to increase care, but does not tackle supplemental reductions. Experts have mentioned that payment incentives underneath latest law may possibly not be adequate to motivate SNFs to strengthen their staffing, which in change could guide to reductions in crucial incidents. Without stronger payment incentives, Medicare is not likely to reduce the billions in spending on likely preventable important incidents or the affected person damage that can arise from them.

Why GAO Did This Research

In 2019, Medicare invested just about $28 billion on care presented to 1.5 million beneficiaries in SNFs—a form of nursing facilty that supplies inhabitants limited-term rehabilitation treatment just after a medical center keep alternatively than long-phrase nursing dwelling treatment that Medicare does not cover. SNFs ought to fulfill federal criteria to participate in Medicare. CMS prices SNFs on aspects such as staffing and top quality of treatment and publishes its ratings on the Care Examine site.

GAO was requested to take a look at SNF staffing and rates of important incidents. This report examines (among the other targets): SNF functionality on staffing steps, CMS reporting of staffing info on Treatment Compare, and Medicare payments for vital incidents. GAO analyzed CMS staffing and crucial incidents data, data on Care Look at, and Medicare promises data for 2018 and 2019. GAO also interviewed CMS officers and other stakeholders this sort of as key scientists and beneficiary groups.