Deeper Than the Headlines: Workplan Updates November 2018

In November we saw some new updates to the OIG Workplan. Make sure you review all of them to see if your organization will be affected. Below you’ll find some highlights that I found the most interesting.

Assessing Inpatient Hospital Billing for Medicare Beneficiaries

In 2016, hospitals billed Medicare $114 billion for inpatient hospital stays, accounting for 17% of all Medicare payments. The Centers for Medicare & Medicaid Services and the Office of Inspector General have identified problems with upcoding in hospital billing: the practice of miscoding or over-coding to increase payment. The OIG will conduct a two-part study to assess inpatient hospital billing. The first part will analyze Medicare claims data to provide landscape information about hospital billing. They will determine how inpatient hospital billing has changed over time and describe how inpatient billing varied among hospitals. OIG will then use the results of this analysis to target certain hospitals or codes for a medical review to determine the extent to which the hospitals billed incorrect codes.

Involuntary Transfer and Discharge in Nursing Homes

The involuntary transfer or discharge of a resident of a nursing home can be unsafe and a traumatic experience for the resident and his or her family. To address these concerns, Congress passed the Nursing Home Reform Act of 1987 to protect residents against involuntary transfer and discharge. However, data from the National Ombudsman Reporting System show that from 2011 through 2016, the Long-Term Care Ombudsman Program, established to advocate for older Americans by the Older Americans Act of 1965, cited complaints related to "discharge/eviction" more frequently than any other concern. In addition, the media has recently highlighted the rise in nursing home evictions. CMS estimates that as many as one-third of all residents in long-term care facilities are involuntarily discharged. The OIG plans to determine the extent to which State long-term care ombudsmen address involuntary transfers and discharges from nursing homes and the extent to which State survey agencies investigated and took enforcement actions against nursing homes for inappropriate involuntary transfers and discharges. They will also examine the extent to which nursing homes meet CMS requirements for involuntary transfers and discharges.

Protecting Medicare Hospice Beneficiaries from Harm

The Medicare hospice program is an important benefit for beneficiaries and their families and caregivers at the end of a beneficiary's life. Surveys and complaint investigations are critical to oversight of the care hospices provide to beneficiaries. This OIG study will be a companion to “Trends in Hospice Deficiencies and Complaints” (OEI-02-17-00020), in which the OIG determines the extent and nature of hospice deficiencies and complaints and identify trends. For this study, OIG will use the survey reports to provide more detail about poor-quality care that resulted in harm to beneficiaries. They will describe specific instances of harm to Medicare hospice beneficiaries and identify the vulnerabilities in Medicare's process for preventing and addressing harm.

Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries - 10-Year Update

OIG has conducted studies about adverse events (patient harm) in various healthcare settings since 2008, with 15 reports released or in the process of release through 2019. The series includes a congressionally-mandated study released in 2010 that found that 27 percent of Medicare beneficiaries experienced adverse events or temporary harm events while hospitalized in 2008. The current study will replicate the methodology used in the prior work for a sample of Medicare beneficiaries admitted to acute-care hospitals in 2018. OIG will measure the incidence of adverse events and temporary harm events, the extent to which the harms were preventable given better care, and the associated costs to Medicare. OIG will compare the 2018 results with the prior study results to assess progress in reducing harm at the 10-year mark, and identify differences in harm rates, types, contributing factors, preventability, and costs.

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