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OIG Reports Find Deficiencies in Hospice Care and Resulting Harms to Patients

Laura Joszt
Two reports from the Office of Inspector General (OIG) in HHS have identified deficiencies in the quality of care at hospices and the harm done to beneficiaries as a result of poor care or cases of abuse.
The majority of hospices in the United States have at least 1 deficiency in the quality of care they provide, and beneficiaries have been harmed as a result of that poor care or cases of abuse, according to 2 reports from the Office of Inspector General (OIG) in HHS.

The first report identified hospice deficiencies based on data from 2012 to 2016, including survey reports from state agencies. OIG found that over the 5 years more than 80% of hospices providing care to Medicare beneficiaries had at least 1 deficiency.

The proportion of hospices with at least 1 deficiency was consistently high, but it had increased from 69% in 2012 to a high of 76% in 2015 before slightly dipping to 74% in 2016. Performance varied by state with 50% of hospices having a deficiency in Maine compared with 99% in Michigan.

Most (70%) of the hospices with a deficiency in 2016 had multiple deficiencies from 2012 to 2016 and 29% of the hospices had at least 1 serious deficiency—the capability to provide adequate care was limited or the health and safety of beneficiaries were in jeopardy. From 2012 to 2016, the percentage of hospices with a serious deficiency sharply increased from 74 in 2012 to 292 in 2015 before dipping to 225 in 2016.

According to the report, common types of deficiencies included poor care planning, mismanagement of aide services, and inadequate assessments of beneficiaries. OIG found that some hospices put beneficiaries at risk of suffering unnecessary pain and discomfort by failing to manage pain, not properly treating severe wounds, and failing to provide volunteer services. Furthermore, some hospices failed to coordinate with the beneficiary’s physician and did not notify the physician of symptoms.

The second report featured 12 cases of harm, identified vulnerabilities that led to the harm, and determined how to prevent it in the future. Some of the cases evaluated included not treating wounds and allowing them to worsen, not providing necessary respiratory therapy services, and not recognizing signs of a possible sexual assault. The report also highlighted instances when hospices were not cited in cases of significant beneficiary harm, such as when a hospice did not provide essential pain management services or did not care for a beneficiary vomiting blood.

Vulnerabilities that the report identified include insufficient reporting requirements and a lack of serious consequences for harming beneficiaries.

Based on the 12 cases evaluated, OIG recommended 5 safeguards CMS can take:
  1. Strengthen requirements for hospices to report abuse, neglect, and other harm;
  2. Ensure hospices educate staff to recognize signs of abuse, neglect, and other harm;
  3. Strength guidance for surveyors to report crimes to local law enforcement;
  4. Monitor surveyors’ use of immediate jeopardy;
  5. Improve and make more user friendly the process for beneficiaries and caregivers to make complains.
“The findings make clear the need for CMS to strengthen its oversight of the Medicare hospice program to better protect both the program and its beneficiaries,” according to OIG.

 
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