Regulators Work to Strengthen Hospice Oversight

Congress is moving to give the U.S. Centers for Medicare & Medicaid Services (CMS) more authority to crack down on quality problems six months after the U.S. Department of Health and Human Services Office of the Inspector General (OIG) criticized the agency in two reports for not more closely enforcing hospice regulations. Meanwhile, CMS is expected to release more guidance for states and accreditors to strengthen the survey process.

The OIG reports found that hospices surveyed in 2016 on average had four deficiencies. Meanwhile, between 2012 and 2016, 20% of hospices had at least one condition-level deficiency that jeopardized patient safety and health. 

The OIG made several recommendations in the reports for how CMS could step up enforcement, and the office is keeping tabs on CMS’ programs, according to Assistant Inspector General for Evaluations and Inspections Erin Bliss.

“We are actively engaged with CMS program officials through regular meetings and status updates,” Bliss wrote in an email to Hospice News. “They have made progress, and there is still more to be done.”

CMS didn’t respond to questions about its progress on the recommendations, such as one that would add state survey reports to Hospice Compare. However, a CMS source said the agency plans to post complaint surveys for all Medicare-certified providers on the agency’s Quality and Certification Oversight Reports website in coming months.

Some in the hospice industry are skeptical about how helpful posting surveys — including complaint surveys — will be to consumers. Christy Whitney Borchard, president and CEO of nonprofit hospice provider HopeWest, said regulators in her home state of Colorado already post these surveys, including deficiencies and complaints. But she said she doesn’t think the public information makes hospices safer or more compliant. 

“Ninety-nine out of 100 people don’t know Hospice Compare exists; the consumers don’t use it, and it doesn’t have the impact they [CMS] think,” Borchard said. “I don’t think that consumers are checking the website before they put a dying loved one in hospice.”

Two bills currently before Congress, one in the Senate and and one in the House would give authority to CMS to also post independent accreditation survey reports on Hospice Compare. But Theresa Forster, vice president for Hospice Policy and Programs at the National Association for Home Care and Hospice, agreed with Borchard’s sentiment: Increasing transparency is good, but only if consumers can understand the information.

“You really need some sort of summary,” Forster said. “CMS is going to need to look at what are the most important items.”

Forster also said CMS is working on hospice survey report revisions that the agency expects to release this spring. The revisions might come in the form of guidance following a recommendation from the OIG to enhance information reported by accrediting organizations.

“It’s my understanding that CMS has taken a look inward at ways to make changes to the survey process so it can be responsive to the OIG,” Forster said.

She said this change will affect hospice providers and require retraining of staff on surveyors’ new priorities.

The House bill, Helping Our Senior Population in Comfort Environments Act, also includes a provision to increase survey frequency to every other year, which Forster said will put more of a burden on hospices.

“When they come to review your program, it does take up a lot of man hours, so there are costs associated with the hours that are connected to providing support to the survey process,” Forster said.

The House bill also calls for a program that requires poor performing hospices, or about 18% of all hospices surveyed in 2016, to undergo a survey every six months. Forster indicated that the House is expected to move on its version of the bill before the Senate.

National Hospice and Palliative Care Organization President and CEO Edo Banach said his group doesn’t want to see a one-size-fits-all approach because the majority of hospices follow the rules.

“Folks [who] are consistently doing the job the way that it needs to be done, honestly should be subject to less scrutiny,” Banach told Hospice News.

The intensified scrutiny would also come in the form of civil monetary penalties of up to $10,000 a day for being out of compliance. Banach said this provision in the House version could have unintended consequences.

“Getting hit with $10,000 a day fine could put you out of business, and you may be the only option available in that service area if you’re in a rural area,” Banach said. 

Written by: Lisa Gillespie