Quality of Care Under Medicare

DHHS OIG REPORT: “Consecutive Medicare Inpatient Stays,” (US Department of Health and Human Services, Office of Inspector General, OEI-03-01-00430, June 2005, .pdf format, 21p.).

Summary:

This inspection found that 20 percent of sequences of three or more consecutive Medicare inpatient stays were associated with quality of care problems and/or unnecessary fragmentation of health care services across multiple inpatient stays.  Quality of care problems were defined as patient care that did not meet professionally recognized standards, medical errors, or accidents.  Unnecessary fragmentation of services involved cases in which care provided across sequences of multiple inpatient stays may have been necessary and appropriate, but should have been consolidated to fewer stays.  Medicare paid an estimated $267 million for these sequences of stays in Fiscal Year 2002.  This inspection also found that 10 percent of individual stays within consecutive inpatient stay sequences were associated with poor quality of patient care.  OIG recommended that CMS direct Quality Improvement Organizations and fiscal intermediaries, as appropriate, to monitor the quality, medical necessity, and appropriateness of inpatient services provided within the types of sequences of consecutive Medicare inpatient stays that we included in our review. 

CMS concurred with OIG’s findings, but stated that periodic reviews of sequences of consecutive inpatient stays are not warranted.

[That CMS!!  Always looking out for its constituents’ best interests! –Ed.]