S. 2807
by Kristin Easterling

The Office of the Inspector General (OIG) recently issued reports identifying concerns about some hospice providers’ performance on quality and safety surveys, as well as potential threats to patient safety. In response, Senators Rob Portman and Ben Cardin introduced the Hospice Care Improvement Act of 2019 (S. 2807), which would reform the hospice survey process, improve compliance and increase transparency related to hospice survey performance.


In a November 2019 OIG survey of approximately 189,000 high-risk date-pairs, the OIG identified:

(1) an estimated 99,000 instances in which registered nurses did not make supervisory visits at least once every 14 days, and

(2) an estimated 5,000 instances in which supervisory visits were not documented in accordance with federal requirements.

The bill takes important steps toward addressing issues identified by the OIG reports by:

  • Addressing the need for greater transparency of survey compliance through:
    • Requiring uniform collection and reporting of hospice survey findings
    •  Making survey information publicly available online
    • Including stakeholders in the process of identifying key survey findings that link to quality of care for use in published summaries of survey findings
    • Requiring annual reports on hospice survey performance
  • Making triennial surveys permanent
  • Requiring more frequent surveys for hospices subject to intermediate sanctions and new providers entering the program
  • Requiring state and accrediting organization surveyors to alert hospices to areas of concern when a survey concludes, and to provide educational support to assist with improvement on survey performance
  • Development of intermediate sanctions that would include:
    • payment suspension
    • temporary management
    • directed plans of correction
    • mandatory staff in-service training

Did You Know?

Between 2000 and 2017:

  • The percentage of Medicare beneficiaries using hospice increased from approximately 23% to 50.4%.
  • Medicare hospice spending grew from $2.9 billion to $17.9 billion.
  • The number of patients served annually rose from approximately 500,000 to 1.5 million.

(Source: MedPac report to Congress, March 2019)

This bill is currently in committee. The National Association for Home Care & Hospice supports the bill.

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Kristin Easterling is managing editor of HomeCare magazine.