Hospice Deficiencies Pose Risks to Medicare Beneficiaries

WHY WE DID THIS STUDY

The Office of Inspector General (OIG) has identified significant vulnerabilities in the Medicare hospice benefit and found that hospices did not always provide needed services to beneficiaries and sometimes provided poor quality care. Hospice care can provide great comfort to beneficiaries, their families, and other caregivers at the end of a beneficiary's life. To promote compliance and quality of care, the Centers for Medicare & Medicaid Services (CMS) relies on State agencies and accrediting organizations to survey hospices. As part of this process, surveyors review clinical records, visit patients, and cite hospices with deficiencies when they do not meet Medicare requirements. Hospices must be surveyed at least once every 3 years. Surveyors also investigate complaints. This report provides a first-time look at hospice deficiencies nation-wide in that it includes both hospices that were surveyed by State agencies and those surveyed by accrediting organizations. This report is the first in a two-part series. The companion report addresses beneficiary harm in depth.

HOW WE DID THIS STUDY

We based this study on an analysis of CMS's deficiency and complaint data from 2012 through 2016. We analyzed data from State agencies and accrediting organizations. We also reviewed the survey reports from State agencies for a purposive sample of 50 serious deficiencies.

WHAT WE FOUND

Hospices are reviewed onsite by surveyors from either State agencies or accrediting organizations. These surveys are key to ensuring quality care. Surveyors cite the hospice with a deficiency if it fails to meet a requirement for participating in the Medicare program. 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. In addition, one-third 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.

WHAT WE RECOMMEND

The findings provide further evidence that CMS should implement existing OIG recommendations to strengthen the survey process, establish additional enforcement remedies, and provide more information to beneficiaries and their caregivers. We also make several new recommendations. CMS should: (1) expand the deficiency data that accrediting organizations report to CMS and use these data to strengthen its oversight of hospices; (2) take the steps necessary to seek statutory authority to include information from accrediting organizations on Hospice Compare, CMS's website that contains limited information about individual hospices; (3) include on Hospice Compare the survey reports from State agencies; (4) include on Hospice Compare the survey reports from accrediting organizations, once authority is obtained; (5) educate hospices about common deficiencies and those that pose particular risks to beneficiaries; and (6) increase oversight of hospices with a history of serious deficiencies. CMS either concurred or partially concurred with all the recommendations except the third.