BIRMINGHAM, Ala. (July 9, 2019)—More than 80% of Medicare-reimbursed hospice agencies were cited with a deficiency between 2012 and 2016, according to a new report issued by the U.S. Office of Health and Human Services (HHS); in 2016, 300--or 18% of all hospices in the country--had serious problems or complaints.

The two-part report, which revealed major deficiencies in the Medicare Hospice Benefit, potentially putting hospice patients at risk, was released by the HHS Office of Inspector General, which recommended that the Centers for Medicare & Medicaid Services (CMS) should tighten enforcement and provide more information to patients and families.

"It is essential that CMS take action to hold hospices accountable and protect beneficiaries and the program," the report reads.

To be eligible for Medicare hospice care, a beneficiary must be entitled to Medicare Part A and be certified as having a terminal illness with a life expectancy of six months or less if the illness runs its normal course. To participate in Medicare, hospices must be certified as meeting certain federal requirements, called Conditions of Participation (CoPs). These include infection control standards, patient rights, quality assessments and more. In April 2015, hospice organizations were required to be surveyed every three years to verify compliance with CoPs. Either state agencies or a hospice accrediting agency can verify compliance.

According to the first part of the report [2], 87% of the 4,563 included hospices failed to meet at least one requirement for participating in the Medicare programin the five-year period examined. Each year, 69% to 76% of surveyed hospices had at least one deficiency; many were repeat offenders. A deficiency can be standard-level or condition-level depending on the manner and degree to which a hospice satisfies the various standards within each condition. A condition-level deficiency occurs when a hospice violates one or more standards and the hospice’s capacity to furnish adequate care is limited. Hospices must submit a plan of correction for each deficiency.

The report addressed several deficiencies that put patients at risk, including not vetting staff properly (such as conducting criminal background checks) or improperly credentialed staff. Also noted in the report were errors in patient needs assessments, such as failure to properly manage pain, treat severe wounds and provide volunteer services. Overall, the report identified 313 hospices as poor performers nationwide for 2016.

The second part of the report [3]detailed 12 cases of harm due to poor hospice care from 2016.

Theresa M. Forster, vice president for hospice policy and programs at the National Association for Home Care & Hospice, said that there have been efforts in recent years to increase hospice providers' accountability, but more can be done.

"The findings of the OIG sends a clear message that more action is required to safeguard vulnerable hospice patients," she said. "CMS, states, accrediting organizations, hospice associations and hospice providers must all address existing gaps in oversight of hospice quality of care so the problems cited in the report are eliminated. NAHC fully agrees that safety of hospice patients cannot be compromised."

At the same time, she said, corrective efforts should be based upon--and prioritize--actual deficiencies.

"The egregious examples of harm discovered by the OIG require an immediate focus on the small number of providers with incidents of jeopardizing patient safety," she said. "CMS should employ a variety of methods to address these agencies’ failings, including subjecting them to the closest of scrutiny until they are able to demonstrate the ability to meet quality standards and the conditions of participation on an ongoing basis.”

Noting that consumers are often left in the dark regarding hospice CoP violations and deficiencies, the OIG recommended tthat CMS update and improve the Hospice Compare website to provide more transparency about the quality of care provided by hospice agencies. OIG also recommended CMS remove barriers to consumers filing complaints against agencies under the Medicare program.

“A number of the OIG’s recommendations center on increased public availability of hospice survey data for use by consumers, referring providers and others," Forster added in her statement. "It is our understanding that CMS is working to build the capacity of Hospice Compare to incorporate this type of information. NAHC recognizes the value of such transparency and the benefit that this type of information can supply, but strongly believes that such action should only be taken when data from all survey organizations is available for posting, the data is comparable across hospice providers, and the data is displayed in a clear and understandable way.”

Find an infographic detailing the OIG recommendations to CMS here [4].