Since 2009, Medicare has paid approximately $5.1 billion for skilled nursing facility stays that did not meet quality-of-care requirements, according to a report by HHS' Office of Inspector General.
The report, "Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements," discusses SNFs' compliance with Medicare requirements of developing a care plan for beneficiaries, providing services in accordance with the care plan and planning for each beneficiary's discharge.
OIG conducted a medical record review of a random sample of SNF stays from 2009. SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans in 37 percent of stays. For 31 percent of stays, SNFs did not meet discharge planning requirements, according to the report. Medicare paid approximately $5.1 billion for these stays in which SNFs did not meet requirements. Medicare paid a total of $32.2 billion for SNF services in FY 2012.
OIG also found examples of poor quality of care for wound care, medication management and therapy, according to the report.
In light of its findings, OIG made five recommendations to CMS, including strengthening regulations on care planning and discharge planning and linking payments to meeting quality-of-care requirements. CMS concurred with all recommendations.
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The report, "Skilled Nursing Facilities Often Fail to Meet Care Planning and Discharge Planning Requirements," discusses SNFs' compliance with Medicare requirements of developing a care plan for beneficiaries, providing services in accordance with the care plan and planning for each beneficiary's discharge.
OIG conducted a medical record review of a random sample of SNF stays from 2009. SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans in 37 percent of stays. For 31 percent of stays, SNFs did not meet discharge planning requirements, according to the report. Medicare paid approximately $5.1 billion for these stays in which SNFs did not meet requirements. Medicare paid a total of $32.2 billion for SNF services in FY 2012.
OIG also found examples of poor quality of care for wound care, medication management and therapy, according to the report.
In light of its findings, OIG made five recommendations to CMS, including strengthening regulations on care planning and discharge planning and linking payments to meeting quality-of-care requirements. CMS concurred with all recommendations.
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