Home Health, Hospice

GAO report: Give CMS more power to enforce hospice safety requirements

The U.S. Government Accountability Office (GAO) recommends giving CMS the authority to “enforce remedies” for hospices that fail to meet federal health and safety requirements, according to a November report.

The study found that in 2017, 472 hospice providers discharged at least 50% of beneficiaries before death. And 83 providers didn’t have hospice staff visit beneficiaries within the last three days of life.

“According to research, a high discharge rate could, in some cases, be an indicator of poor quality of care or of provider misuse of the benefit, in that the hospice may be enrolling beneficiaries who are not eligible for hospice care,” according to the GAO.

The study goes on to explain that CMS doesn’t instruct surveyors to use information on provider performance on quality measures or other quality indicators as part of the survey process and that CMS’ sole enforcement option is termination from Medicare.

“According to two researchers, additional remedies, such as civil monetary penalties, could enhance CMS’s oversight by addressing performance problems that do not merit termination and incentivize agencies to improve quality of care. CMS uses a range of remedies for other provider types, such as home health agencies and nursing homes, but lacks authority to impose such additional sanctions on hospices,” the report states.

The GAO recommends incorporating into surveys the use of additional information to identify quality of care issues. The report also recommends giving CMS the ability to establish other enforcement options for hospices.

Related link: View the report online at https://www.gao.gov/products/GAO-20-10.