Archive for July, 2011

PostHeaderIcon The High Cost of Poor Care

Nearly 388,000 nursing home residents’ deaths each year are attributed to infections. Approximately 25% of all hospitalizations of nursing home residents are caused by infections; the costs range from $673 million to $2 billion.

The FDA issued “black box” warnings against prescribing atypical antipsychotic drugs for patients with dementia, cautioning that the drugs increased dementia patients’ mortality. At the same time CMS reports that, nationwide, 39.4% of nursing home residents who had cognitive impairments and behavior problems but no diagnosis of psychosis or related conditions received antipsychotic drugs.

Use of chemical restraints is a major cause of nursing home falls, including hip fractures, which are estimated to cost $746.5 million.

Lack of toileting leads to urinary incontinence, in turn it leads to skin irritation, decubitus ulcers, urinary tract infections, and additional nursing home admission and hospitalization. Estimated cost $3.26 billion annually.

Poor hydration, along with poor nutrition, decreased mobility and cleanliness leads to pressure ulcers. Treatment costs are estimated to range between $1.2 and $12 billion.

Hospitalization of a dehydrated nursing home resident costs, on average, more than $18,000. Dehydration is often avoidable if residents are given more fluids. Insufficient staffing leads to less fluid intake by residents.

Three-quarters of all nursing home 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.

Poor care leads to excess hospitalizations, costing nearly $1 million.

Present plans by our government to fix nursing home expenses for Medicare and Medicaid patients:

Medicare-Medicaid Coordinating Office (MMCO) was established under the authority of the PPACA to address cost of care and improve access.

There are three initiatives in the works.

1. Capitated model – basically contracting with insurance companies to create a blended Medicare-Medicaid rate

2. Fee-for-service model- this model supposed to share savings from Medicare hospitalization reduction due to better quality care in dual eligible nursing home residents within each state.

3. Improved Care Quality for Nursing Facility Residents – this project plans to contract with independent entities to implement better practices to prevent conditions that leads to hospitalizations. The project aims to target 150 Skilled Nursing Facilities with high rate of hospitalizations. (Will observation be counted into these admissions?)

The real fix is simply having more nurses and nurse aides to provide better care.