By Wolters Kluwer Editorial Staff
An estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehabilitation (rehab) hospital stays, resulting in: (1) temporary harm; (2) prolonged stays or transfers to other hospitals; (3) permanent harm; (4) life-sustaining intervention; or (5) death, according to a study conducted by the HHS Office of Inspector General (OIG). The OIG noted that this harm rate is in line with what it found in its previous studies for hospitals (27 percent) and in skilled nursing facilities (SNFs) (33 percent) (OIG Report, OEI-06-14-00110, July 21, 2016).
Rehab hospitals are postacute providers that specialize in intensive rehabilitative care for patients recovering from an illness, an injury, or a surgery. The OIG notes that while in recent years considerable attention has been given to patient safety in acute-care hospitals and increasingly in SNFs, less is known about adverse events in other health care settings, including rehab hospitals.
Previous OIG work identified harm rates of about 30 percent in both acute-care hospitals and SNFs. Beyond the toll on patient health, the monetary cost of adverse events to taxpayers amounts to billions annually. As a result, the OIG undertook evaluation of adverse events occurring during rehab hospital stays. To estimate the national incidence rate, preventability, and costs of adverse events in rehab hospitals, the OIG reviewed a nationally representative sample of 417 Medicare beneficiaries discharged from rehab hospitals in March 2012.
Adverse or temporary harm event. Almost 29 percent of Medicare beneficiaries who had rehab hospital stays that ended in March 2012 experienced at least one adverse (10 percent) or temporary harm (18 percent) event during their stay. However, less than one percent of Medicare beneficiaries in rehab hospitals experienced events that led to death. Medication and patient care led to most of the adverse and temporary harm events affecting patients. Physician reviewers determined that 46 percent of these adverse and temporary harm events were clearly or likely preventable, which is similar to the OIG’s previous results for hospitals (44 percent) and SNFs (59 percent). Physicians attributed much of the preventable harm to substandard treatment, inadequate patient monitoring, and failure to provide the needed treatment.
Cost to Medicare. The OIG noted that nearly one-quarter of the patients who experienced adverse or temporary harm events at rehab hospitals were transferred to an acute-care hospital for treatment, with an estimated cost to Medicare of at least $7.7 million in one month, or at least $92 million annualized in one year (2012), assuming a constant rate of hospitalization throughout the year. The OIG noted that this presented an opportunity for savings from reducing the incidence of adverse events that occur in rehab hospitals.
Recommendations. The OIG noted the fact that the incidence of adverse events in rehab hospitals is similar to that in acute-care hospitals and SNFs, which was also reflected in its previous findings (see Estimated 22 percent of Medicare patients on post-acute stays experienced adverse events, March 4, 2014), suggests that research and interventions to reduce adverse and temporary harm events may be applicable across multiple health care settings. The OIG suggested that using the information presented in its report, health care providers could take actions to further understand the causes of adverse events in rehab hospitals and reduce the incidence and impact of these events.
The OIG specifically recommended that the Agency for Healthcare Research and Quality (AHRQ) and CMS raise awareness of patient safety issues in rehab hospitals and seek to reduce patient harm by: (1) collaboration to create and disseminate a list of potential adverse events that occur in rehab hospitals; and (2) the addition of information about potential adverse events in quality guidance to rehab hospitals.
CMS and AHRQ concurred with the OIG’s recommendations.
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