Medicare Your Coverage Options

Choose your hospice carefully

Written by Diane Archer

The HHS Office of the Inspector General just issued two scathing reports on the Medicare hospice program. It found that nearly one in five hospice agencies suffered from serious deficiencies that put patient health and safety at risk. And more than four in five had at least one deficiency. Choose your hospice carefully.

The Medicare hospice benefit can be extremely valuable to patients who choose palliative or comfort care rather than curative care at the end of life. Usually, care is provided in the person’s home. But, it can also be provided in an assisted living facility or skilled nursing facility. Some hospices have their own hospice inpatient unit.

But, not all hospice care is the same. We do not know which specific hospice agencies the OIG found suffered from serious deficiencies or how many of the 1.5 million Medicare patients in hospice are endangered. The OIG examined only a small number of cases. It described a case in which a dying man’s feeding tube had maggots growing on it. And, it reported on a patient with Alzheimer’s going without appropriate wound care, which caused her to need her leg amputated.

The Centers for Medicare and Medicaid Services (CMS), however, apparently does not have adequate authority to hold these companies to account when they cause harm to patients. CMS’ only available penalty is to end its contract with hospice agencies, which CMS has not chosen to do. Consequently, hospice agencies can cause harm to patients with apparent impunity. The OIG recommends that CMS have greater legal authority to penalize these hospice agencies.

The OIG recommends Congress give CMS the authority to impose fines on hospice agencies, authority CMS already has for nursing facilities. That said, CMS does little to use that authority with nursing homes. And, why is CMS not simply terminating contracts with the facilities that put patients at risk because of their serious deficiencies?

Moreover, why isn’t CMS flagging the agencies that have serious deficiencies on Hospice Compare, a government tool to help people choose a hospice agency. CMS has chosen not to publish state agency reports showing deficiencies because “they may be misleading.” CMS claims that state reports on hospice violations should not be available on Hospice Compare. As of now, survey reports from accrediting organizations, such as NCQA, the National Committee for Quality Assurance, cannot be publicly disclosed. But, that may change.

CMS argues that Medicare-certified hospices are required to meet federal health and safety standards that keep patients safe. But, it clearly is not ensuring that they do. Before you choose a hospice agency, do your homework. Check with your state to learn about deficiencies the state has found with hospice agencies.

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