219395 Trends in Medicare Part A payments to skilled nursing facilities

Tuesday, November 9, 2010 : 4:45 PM - 5:00 PM

US Department of Health and Human Services Office of Inspector General , HHS, OIG, New York, NY
Jodi Nudelman, Regional Inspector General , HHS, OIG, New York, NY
Meridith Seife, Deputy Regional Inspector General , HHS, OIG, New York, NY
Judy Kellis, Program Analyst , HHS, OIG, New York, NY
Judy Bartlett, MPH, PhD , HHS, OIG, New York, NY
Christine Moundas, Program Analyst , HHS, OIG, New York, NY
Rachel Siman, Program Analyst , HHS, OIG, New York, NY
In recent years, the Office of Inspector General (OIG) of the US Department of Health and Human Services has identified vulnerabilities with Medicare Part A services provided by nursing homes. This Medicare benefit covers skilled nursing and rehabilitation services for elderly and disabled beneficiaries residing in nursing homes. A continuing concern is that certain nursing homes may be providing inappropriate care to beneficiaries in order to maximize payments. For example, a nursing home may provide more therapy than necessary or keep beneficiaries in Part A stays longer than necessary. While OIG has a long history of evaluating nursing home services, this report is novel in its extensive use of data integration and analysis. The analysis uses data from three sources: (1) the National Claims History file, providing information about Medicare Part A claims submitted from 2006 to 2008; (2) the Online Survey, Certification and Reporting database, providing information about the 15,000 nursing homes that provided Part A services during those years; and (3) the Minimum Data Set, providing information about beneficiaries' care and resource needs during their Part A stays. The report, which will be published this summer, will describe trends in Part A payments to nursing homes and will identify nursing homes that may be inappropriately maximizing payments. It will also include recommendations for reducing abuse within the Medicare Part A program.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
1. List at least one source of data that researchers can use to analyze Part A stays in nursing homes. 2. Identify at least one trend in Medicare Part A payments to nursing homes between 2006 and 2008. 3. Articulate how the Office of Inspector General identified nursing homes that may be inappropriately maximizing payments for Part A stays.

Keywords: Nursing Homes, Medicare

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was a lead member of the HHS OIG team that worked on this report. In particular, I had primary responsibility for the data integration and analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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