The vast majority of U.S. hospice providers violated at least one safety requirement for Medicare participation over the span of five years, according to new reports from HHS' Office of Inspector General.
The two reports, published Tuesday, found that 87% of 4,563 hospices were cited for at least one deficiency for Medicare participation from 2012 through 2016. Additionally, the OIG found the number of hospices that had severe complaints filed against them more than tripled over the same period.
The OIG said the findings "make clear" that the CMS needs to strengthen its oversight of hospices.
The most common deficiencies the facilities were cited for were poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries.
In response to the reports, a CMS spokeswoman said in an email statement that the agency "has zero tolerance for abuse and mistreatment of any patient, and CMS requires that every Medicare-certified hospice meet basic federal health and safety standards to keep patients safe."
She added, "The OIG's findings are based on cases that occurred between 2012 and 2016, a selective sample of the most serious cases of harm found during hospice surveys. In these cases, CMS cited the hospices for failing to meet certain requirements in the Medicare or Medicaid programs."
The OIG recommended the CMS take several actions to improve hospice oversight. One suggestion was for the CMS to post on Hospice Compare deficiency data from surveys conducted by private accrediting organization. However, the CMS is legally prohibited from publicly releasing surveys conducted by accrediting organizations. The agency attempted to change that through a proposed rule, but abandoned the effort after overwhelming pushback.
Even so, the OIG recommended the CMS still post individual survey reports from state agencies on Hospice Compare. They are already publicly available. The CMS disagreed with the suggestion, saying that might be misleading to consumers.
The OIG also suggested the CMS "identify and target hospices with a history of serious deficiencies." Those hospices can then be given additional education and assistance. The frequency of surveys could also be increased. Hospices are currently surveyed every three years. The CMS supported that suggestion.
One of the reports highlighted 12 cases of severe harm to hospice patients in 2016. The 12 cases were selected from a sample of 50 and meant "to gain an understanding of CMS' efforts to prevent and address beneficiary harm."
The OIG found that the determination of immediate jeopardy, which indicates an organization's noncompliance with safety requirements led to serious patient injury or even death, was inadequate. Despite patients experiencing severe harm in each of the 12 cases, only five of the hospices were cited for immediate jeopardy.
The CMS recently revised its guidance on immediate jeopardy but the OIG pointed out that it removed instructions to call law enforcement when such situations occur. The OIG recommended the CMS reinstate that instruction and expand it to all instances of suspected abuse.
"CMS should ensure that surveyors or state agencies are required to always contact law enforcement if they suspect a crime was committed, regardless of a finding of immediate jeopardy," the OIG said.
In response, the CMS said it agreed with the suggestion.
The reports are the first by the OIG to review hospice deficiencies at the national level.