Department of Health and Human Services (HHS) Survey Finds That Many Skilled Nursing Facilities (SNFs) Fail to Meet Legal Requirements for Care Plans
Skilled nursing facilities (SNF) are required to develop a care
plan for each beneficiary and provide services in accordance with the care
plan, as well as to plan for each beneficiary's discharge. These requirements
are essential to ensuring that beneficiaries receive appropriate care and
safely transition from one care setting to another. Several OIG studies and
investigations found that SNFs had deficiencies in quality of care, did not
develop appropriate care plans, and failed to provide adequate care to
beneficiaries. In fiscal year 2012, Medicare paid $32.2 billion for SNF
services. This study is part of a larger body of work about SNF payments and
quality of care. For 37 percent of stays, SNFs did not develop care plans that
met requirements or did not provide services in accordance with care plans. For
31 percent of stays, SNFs did not meet discharge planning requirements.
Medicare paid approximately $5.1 billion for stays in which SNFs did not meet
these quality-of-care requirements. Additionally, reviewers found examples of
poor quality care related to wound care, medication management, and therapy.
These findings raise concerns about what Medicare is paying for. They also
demonstrate that SNF oversight needs to be strengthened to ensure that SNFs
perform appropriate care planning and discharge planning.