Senators Introduce Bill on Hospice Quality, Transparency

U.S. Senators Rob Portman (R-Ohio) and Ben Cardin (D-Md.) have introduced a new bill, the Hospice Care Improvement Act, in response to the July reports on hospice quality from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS).

If enacted, the legislation would implement new rules for oversight and transparency, including public reporting of hospice survey results, providing education to hospices and surveyors related to quality issues, and establishing penalties for providers that have a track record of poor quality or instances of abuse or neglect. The penalties would be comparable to those applied to other health care settings, such as nursing homes and home health care providers.

“The findings from the HHS OIG report on hospice care abuse across our country are deeply upsetting and unacceptable,” Portman said in a statement. “A hospice patient should live out their final days with comfort and dignity, and their families should have the peace of mind knowing their loved ones are receiving the best care. This legislation will provide the oversight needed for hospices and give patients and their families the transparency and accountability they deserve.”

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Reps. Jimmy Panetta (D-Calif.) and Tom Reed (R-N.Y.) are introducing a similar bill in the House.

The first OIG report indicated that about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a condition-level deficiency that posed a serious safety risk. A second report discussed 12 examples of those deficiencies in-depth. OIG examined state agency and accreditor survey findings as well as complaint data from 2012 through 2016. Regulators and accreditors surveyed nearly all hospice providers in the nation during those years.

Hospice industry organizations spoke in favor of the bill, the sponsors of which sought input from the field during development.

“We greatly appreciate and applaud the work undertaken by [Portman and Cardin] in developing the Hospice Care Improvement Act of 2019, which is designed to refine the hospice survey process, improve compliance, and increase transparency,” the National Association for Home Care & Hospice indicated to Hospice News in an email. “NAHC is particularly appreciative that Senators Portman and Cardin actively sought input from the hospice community and from other stakeholders in this process.”

The bill would also require the U.S. Centers for Medicare & Medicaid Services (CMS) to provide training to state and local survey agencies, approved accreditation agencies, and hospice programs on a regular basis as changes to regulations, guidelines, and policies governing hospice program operations are implemented and used in standard surveys.

”[The National Hospice & Palliative Care Organization (NHPCO)] supports the reasonable policies outlined in the bipartisan bill introduced by [Portman and Cardin], which focuses on implementing new safeguards and strengthening existing ones in order to protect patients facing serious illness at the end of life,” said NHPCO President and CEO Edo Banach. “NHPCO supports regulations that promote accountability and safety and is eager to work with lawmakers to develop reasonable policies and enforcement mechanisms that promote program integrity.”

Among the significant changes in the bill, related to transparency, is the public reporting of survey results, not only CMS and state agency findings, but those of accreditors such as The Joint Commission, which are currently kept confidential.

Industry experts generally support this move but are urging CMS to take steps to make the arcane reports understandable to patients and families.

“We want to be sure that the data that is made public is done so in a way that makes sense to consumers. So we talked a lot with the senators’ offices, and we’ve also talked to CMS about how to make it public,” said Mollie Gurian, director of hospice, palliative, and home health policy for LeadingAge, who also expressed support for the bill. “If they’re just sort of thrown up with a link with no explanation that can be confusing for consumers. But we think that if certain data points are taken out of the accreditation reports or survey reports, and explained in a way that makes sense for consumers as to why they should care about it, that’s something that that could be that could be positive.”

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