Two (2) OIG Studies Released: Hospice Care Provided to Medicare Beneficiaries

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Last week, the Office of Inspector General (OIG) released 2 reports that describe “specific instances of harm to hospice beneficiaries and identifies vulnerabilities in CMS’s efforts to prevent and address harm” and “hospices did not always provide needed services to beneficiaries and sometimes provided poor quality care.”

Safeguards Must Be Strengthened to Protect Medicare Hospice Beneficiaries from Harm is a 32-page report that purposively chose 12 cases of beneficiary harm from a review of the survey reports from a sample of 50 serious deficiencies in 2016. OIG notes that “these cases do not represent the majority of hospice beneficiaries or hospice providers. They also do not reflect the prevalence of harm to hospice beneficiaries.”

OIG found:

  • Some instances of harm resulted from hospices providing poor care to beneficiaries and some resulted from abuse by caregivers or others and the hospice failing to take action;
  • These cases reveal vulnerabilities in CMS’s efforts to prevent and address harm;
  • These vulnerabilities include insufficient reporting requirements for hospices, limited reporting requirements for surveyors, and barriers that beneficiaries and caregivers face in making complaints and
  • These hospices did not face serious consequences for the harm described in this report. Specifically, surveyors did not always cite immediate jeopardy in cases of significant beneficiary harm and hospices’ plans of correction are not designed to address underlying issues. In addition, CMS cannot impose penalties, other than termination, to hold hospices accountable for harming beneficiaries.

OIG made 5 recommendations to CMS as a result of this safeguards study.

A companion 38-page report – Hospice Deficiencies Pose Risks to Medicare Beneficiaries – shows that this second study was based “on an analysis of CMS’s deficiency and complaint data from 2012 through 2016…OIG analyzed data from State agencies and accrediting organizations and also reviewed the survey reports from State agencies for a purposive sample of 50 serious deficiencies. From 2012 through 2016, nearly all hospices that provided care to Medicare beneficiaries were surveyed. Over 80 percent of these hospices had at least one deficiency.”

The most common types of deficiencies involve:

  • Poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries;
  • In addition to these, hospices had other deficiencies that also posed risks to beneficiaries. These failings-such as improperly vetting staff and inadequate quality control-can jeopardize beneficiaries’ safety and lead to poor care and
  • 1/3 of all hospices that provided care to Medicare beneficiaries had complaints filed against them. Over 300 hospices had at least one serious deficiency or at least one substantiated severe complaint in 2016, which we considered to be poor performers. These hospices represent 18 percent of all hospices surveyed nation-wide in 2016. Most poor performers had other deficiencies or substantiated complaints in the 5-year period. Some poor performers had a history of serious deficiencies.

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OIG made 6 recommendations to CMS as a result of this companion study including those shown in the above graphic.

There are great resources available to hospice providers within this resources hyperlink, including links to both OIG studies, a tearsheet that provides graphics regarding both studies and a Medicare Hospice Patient Rights Flyer.

Both OIG studies are must-reads for hospice providers. I encourage you to also take advantage of the resources provided by OIG.