Government Watchdog Agency Issues Report Highlighting “Significant Vulnerabilities” in Medicare’s Hospice Benefit

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Following up on earlier work analyzing the Medicare hospice benefit, the Department of Health and Human Services (DHSS) Office of Inspector General (OIG) issued two reports this week

“which found that from 2012 through 2016, the majority of U.S. hospices that participated in Medicare had one or more deficiencies in the quality of care they provided to their patients. Some Medicare beneficiaries were seriously harmed when hospices provided poor care or failed to take action in cases of abuse.”

In response to these findings, “OIG made several recommendations in both reports to strengthen safeguards to protect Medicare hospice beneficiaries from harm and to ensure hospices are held accountable for deficiencies in their programs.”

The first report, Hospice Deficiencies Pose Risks to Medicare Beneficiaries (OEI-02-17-00020), looks at the overall quality of care provided to hospice beneficiaries and hospice deficiencies nationwide, including both hospices that were surveyed by State agencies and those surveyed by accrediting organizations. The most common deficiencies found, according to the report, “involved poor care planning, mismanagement of aide services, and inadequate assessments.” Hospices must be surveyed at least once every three years to verify compliance with Medicare requirements. However, the only enforcement action the Centers for Medicare & Medicaid Services (CMS) “can initiate against hospices that do not correct deficiencies is termination from Medicare.” This is compared to enforcement actions (such as civil monetary penalties and denial of payment) available for other types of Medicare providers such as nursing facilities and home health agencies. Information about individual hospices’ deficiencies are not available on Hospice Compare.

The companion report, Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm (OEI-02-17-00021), explores beneficiary harm in greater depth. It features 12 cases of harm to beneficiaries receiving hospice care, and an examination of “each case to identify vulnerabilities that could have led to the harm and to determine how such harm could be prevented in the future.” OIG notes that these cases “reveal vulnerabilities in [CMS’] efforts to prevent and address harm.” Building on previous recommendations made by OIG, the report makes several new recommendations to CMS to protect beneficiaries from harm.

As part of a package of materials accompanying these reports, OIG also issued a one-page “Know Your Rights, Take Action” flyer aimed toward Medicare hospice patients and their families. OIG also provided a one-page summary of their findings, summarized below (OIG Summary Text):

  • Beneficiaries have limited access to hospice quality of care information. Centers for Medicare & Medicaid Services (CMS) should improve its Hospice Compare website so beneficiaries can be more informed about the quality of care provided by each hospice.
  • Most hospices that participate in Medicare have at least one deficiency in the quality of care they provide, and hundreds are poor performers. CMS should educate hospices about common deficiencies and increase oversight of hospices with a history of serious deficiencies.
  • Hospice beneficiaries face barriers to making complaints, and hospice and surveyor reporting requirements are limited. CMS should make it easier to file complaints and strengthen hospice and surveyor reporting requirements.
  • Hospices with patient harm cases do not always face serious consequences from CMS. CMS should seek statutory authority to extend beneficiary protections found in other health care settings to hospices and ensure remedies are available to address poor performers.

July 11, 2019 – D. Lipschutz

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