The Center for Medicare Advocacy, Inc has a great article on its website entitled "Real Solutions To Save Medicare Dollars In Skilled Nursing Facilities."
The article states "(f)or many years, advocates for nursing home residents have argued that when residents are denied good care, the costs of trying to treat and correct avoidable conditions and bad resident outcomes are high. Advocates refer to this phenomenon as "the high cost of poor care." Others identify the phenomenon as "the business case for quality." Real savings are possible for the Medicare program, including reduced hospitalizations, when nursing home residents are provided better care in their nursing facilities."
According to the article, here two changes that could result in additional savings to the Medicare program:
1. Stop Paying for Antipsychotic Drugs for Nursing Home Residents Who Do Not Have a Diagnosis Supporting Their Use
The article states that 1,263,641 of atypical antipsychotic drug claims (88%) were for nursing home residents who were diagnosed with dementia. In total, 95 percent (nearly 1.4 million) of Medicare claims for atypical antipsychotic drugs were for elderly nursing home residents diagnosed with off-label conditions and/or the condition specified in the boxed warning. The Medicare program spent hundreds of millions of dollars on these drugs in the six-month period
In a May 9, 2011, the Inspector General Daniel R. Levinson wrote, "Too many [nursing homes] fail to comply with federal regulations designed to prevent over medication, giving nursing home patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use." As the Center wrote in an Alert in March 2011, reducing residents' use of both atypical antipsychotic drugs and conventional antipsychotic drugs (which were not studied by the Inspector General) would save hundreds of millions of dollars and improve care for residents.
2. Improve Nurse Staffing Levels in Nursing Homes, Reducing Avoidable Bad Outcomes for Residents and Avoidable Hospitalizations
A decade ago, the Centers for Medicare & Medicaid Services (CMS) documented the inadequate nurse staffing levels in nursing homes nationwide, reporting that 91% of facilities failed to meet one or more staffing requirements to prevent avoidable harm to residents and that 97% lacked sufficient nursing staff to meet five key care processes required by the federal Nursing Home Reform Law (dressing/grooming, exercise, feeding assistance, changing wet clothes and repositioning, toileting).
Ensuring that SNFs employed sufficient numbers of well-trained nursing staff would save Medicare dollars in the long run. A recently-published study of infection control deficiencies in nursing homes found that low nurse staffing at all levels (registered nurses, licensed practical nurses, and nurse aides) was correlated with infection control deficiencies; that nearly 388,000 nursing home residents' deaths each year are attributed to infections; that approximately 25% of all hospitalizations of nursing home residents are caused by infections; and that the costs associated with infections range from $673 million to $2 billion.
The Staff report identified a few of the poor care outcomes, here are just two of the causes and their estimated costs:
- "Lack of toileting leads to urinary incontinence," which leads to "skin irritation, decubitus ulcers, urinary tract infections, additional nursing home admission and hospitalization" and is estimated to cost $3.26 billion annually.
- "Poor hydration, nutrition, mobility and cleanliness lead to pressure ulcers," whose treatment costs are estimated to range between $1.2 and $12 billion.
Most recently, in April 2011, the National Consumer Voice for Quality Long-Term Care (Consumer Voice) issued a new report, The High Cost of Poor Care: The Financial Case for Prevention in American Nursing Homes, which updated its own 20-year old report, The High Cost of Poor Care – The Cost-Effectiveness of Good Care Practices. Here are three examples of the research-based data on the high, and often avoidable, costs of poor care:
- Falls: Studies indicate that three-quarters of all residents have at least one fall each year, and a quarter of the falls require medical attention. Twenty to thirty percent of the falls are preventable. Falls cost, on average, $19,440 and hip fractures, more than $35,000.
- Pressure ulcers: Pressure ulcers are largely preventable, but nevertheless prevalent in nursing homes. The costs to treat them are high. The total annual cost of treating all pressure ulcers (not just those of nursing facility residents) is $11 billion.
- Urinary incontinence: Two-thirds of residents have urinary incontinence, with direct costs of $5.3 billion per year.
Conclusion
Simple, reasonable solutions such as not paying for unnecessary drugs and requiring adequate nursing staff can reduce the federal deficit while actually improving the Medicare program and the quality of care received by beneficiaries. Such solutions are better than simply shifting costs from the federal government to individuals."
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For the full article (including cites) please go to the Center for Medicare Advocacy, Inc's website.