ED Visits By Nursing Home Residents 'Disproportionately High'
Of those, 19% were for ambulatory care sensitive conditions, defined by the Agency for Healthcare Research and Quality as pneumonia, urinary tract infections, and other conditions such as asthma, chronic obstructive pulmonary disease, hypertension, appendicitis, congestive hart failure, dehydration, angina, and complications of diabetes.
Hsia says that it's not surprising that the percentage of skilled nursing home patients transported to an ED for care has risen; nursing home patients are sicker than they were 10 years ago, and more resources are available for patients with lower level of illness severity to be cared for in less intense settings such as home or assisted living residences.
Also, with the aging of the population, the number of skilled nursing home beds has outpaced demand, and if patients are not eligible for Medicare SNF coverage, not all patients and their families can afford the expense.
The issue is becoming increasingly important as hospitals struggle to reduce readmissions from skilled nursing facilities, which in 2006 were estimated at 21% and in 2010, rose to 23% according to Momotazur Rhaman, an investigator in health services policy and practice at Brown University.
Additionally, the Medicare Payment Advisory Commission (MedPAC), has been urging the Centers for Medicare & Medicaid Services to impose financial penalties on skilled nursing facilities with higher rates of 30-day hospital readmissions in a manner similar to CMS' up to 3% financial penalty to hospitals with higher rates of readmissions.
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