Earlier this month, the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) released two reports regarding its concerns and recommendations related to quality of care at hospice facilities (available here and here). These reports follow a portfolio report that the OIG released last summer regarding significant vulnerabilities in the Medicare hospice benefit. (You can find our blog post on last year’s report here.) In these reports, the OIG outlines several quality of care issues and recommends several ways that CMS should strengthen safeguards, all of which may further increase enforcement in an already heavily scrutinized area.
The OIG’s first report focuses on hospice deficiencies in quality of care that could cause harm to Medicare beneficiaries. The OIG reviewed and analyzed deficiency and complaint data from the Centers for Medicare & Medicaid Services (CMS) from 2012 to 2016. Through this analysis, the OIG identified care planning, mismanagement of aide services, and inadequate assessments of beneficiaries as some of the most common types of hospice deficiencies. The OIG also found that over 80% of hospices had at least one deficiency during a routine survey while over 20% had a serious “condition-level” deficiency, which means that “the hospice’s capacity to furnish adequate care is substantially limited or adversely affects the health and safety of patients.”
The OIG’s second report outlines certain safeguards that could be put into place to address the issues identified in the first report. The OIG highlights the fact that CMS has no enforcement tool for hospice deficiencies except for termination of the Medicare enrollment, which CMS does not often do. CMS does not have the ability to enforce civil monetary penalties (CMPs) or withhold Medicare payments to the hospice providers, as it does for certain other provider types like nursing homes and home health agencies. The OIG also noted that surveyors do not often give “immediate jeopardy” citations for cases of significant beneficiary harm, even when it is warranted.
As evidenced by its reports both last year and this year, OIG remains focused on vulnerabilities that it sees in the Medicare hospice program. While the OIG provides a few particularly egregious examples of poor care management and treatment, this may not be representative of hospice facilities as a whole, which provided care for 1.5 million individuals in 2017, as the OIG notes. Hospice providers will likely see continued, if not increased, scrutiny from state and federal enforcement authorities and state agencies. The OIG recommended that CMS seek statutory authority for additional remedies for poor performers, so we will keep watch to see if CMS actually takes action.