OIG - Medical Record Review

The American Health Care Association (AHCA) is reporting that recently, some nursing centers have received letters from the Office of Inspector General (OIG), Office of Evaluation and Inspection (OEI), about conducting a national evaluation of the Department of Health & Human Services’ (HHS) programs.  The OEI will focus on hospitalizations involving patients in the SNF 35 days or less.  OEI plans to sample 800 facilities (SNFs, IRFs and LTC hospitals) using a trigger tool modeled after one used in hospitals.  To help with their evaluation, the OEI is requesting medical records looking at evidence of the hospital discharge planning process and the degree of communication and collaboration between acute-care and post-acute care provider.  The OEI states they will not retain any of the medical records or use names in their findings report.  To date, we are not aware of any Virginia-specific actions – however, given the scope of the sample size, it is reasonable to expect that Virginia nursing facilities will be a part of the evaluation.

Since patients hospitalized within 35 days of discharge from the hospital to the nursing facility appears to be the focus of the OEI survey and in preparation to the OEI request, AHCA recommends that facilities look at their hospitalization rates, programs and tools used to reduce avoidable hospitalizations.  If not already doing so, the AHCA also recommends that centers adopt INTERACT 2 process and tools found at www.INTERACT2.net.  INTERACT is evidenced-based (tested in FL, MA and NY) process with tools to identify and manage acute change in condition to prevent avoidable hospitalizations.  The program includes several tools like a hospitalization tracking record, hospital transfer form, communication tools, care paths for decision making and more.  AHCA recently provided an Introduction to Interact2 webinar which is available for archive viewing.