CMS Releases Top Hospice Survey Deficiencies for 2018

The US Centers for Medicare & Medicaid Services (CMS) has released the top deficiencies identified during recertification surveys for hospices during 2018. As in previous years, problems with care planning topped the list.

Hospices are required to ensure that the care and services they provide follow an individualized written care plan developed by the interdisciplinary care team. It also must state in detail the scope and frequency of the services necessary to meet the patient’s needs.

CMS found that hospices with deficiencies often developed incomplete care plans that lacked appropriate detail, or that staff deviated from the specified plan of care.


One of the requirements for care planning is that the plan must must reflect goals for the patient’s care based on the initial comprehensive assessment of the patient. However, staff in surveyed organizations frequently failed to complete those assessments with in the specified time frame of five days after the patient is admitted to hospice.

Hospices also struggled with supervision of hospice aides. A registered nurse must make on on-site visit no less than every 14 days to assess the quality of care provided by hospices aides. However, in many of the surveyed hospices these visits occurred less often that the 14-day timeframe the CMS Condition of Participation mandates.

Finally, hospices with deficiencies often failed to perform the necessary review of patient medications, over-the-counter drugs, and supplements to assess the effectiveness of drug therapy, side effects, actual or potential drug interactions, duplicate drugs, and ensuring that patients receive any necessary laboratory monitoring related to their medications.