Hospice Deficiencies Pose Risks to Medicare Beneficiaries concludes more than 80 percent of Medicare hospice providers have at least one deficiency in the provision of care. The deficiencies include “poor care planning, mismanagement of aide services, and inadequate assessments,” the report states.
The study also found poor vetting of caregivers and lack of quality controls were common. More than 300 hospices representing 18 percent of Medicare providers had at least one serious deficiency or one substantiated serious complaint causing them to be defined as poor performers.
The study, released in July, reviewed data collected in state onsite inspections between 2012 and 2016.
The findings come as no surprise to Robert Moffit, a senior fellow in domestic policy studies at The Heritage Foundation and author of End of Life Care: Expanding Patient Choice of Ethical Options.
“This is a classic example of the health care system working against what people want, in the freest country in the world, because of the structural restrictions of our health care system,” Moffit said. “Hospice is big, and it’s big in Medicare.”
Moffit says the Medicare fee for service model is a prominent cause of problems.
“I think [fee for service] is a mistake,” Moffit said. “I think we should open [hospice] up to Medicare Advantage and allow people who are in private plans in the Medicare Advantage program to offer hospice benefits and coordinate the care for hospice benefits and develop new and innovative options.”
Medicare Advantage is an alternative way of receiving Medicare benefits. Instead of using fee-for-service, Medicare contracts with private companies for a package of care. Providers compete for beneficiaries on quality and by offering services Medicare does not cover. Medicare Advantage stops at palliative care; beneficiaries are transferred to hospice if given a prognosis of six months or less to live.
“The [Trump] administration could give the Center for Medicare and Medicaid Innovation the responsibility to test within the Medicare Advantage Program,” Moffit said. “That would determine whether private health care plans [are offering] hospice patients improved quality of their care and other cost benefits.”
Another cause of the deficiencies is state certificate of need (CON) programs, says Moffit, who served as the chairman of the Maryland Health Care Commission. CON is a system in which states require health care providers to obtain government permission to open a facility or expand services.
“The hospice industry was opposed to any kind of change [to CON] and wanted to block out competition,” said Moffit. “I think it’s critical for people at the state level … to open up the system, to open up the markets to new and innovative hospice care delivery.”
Currently, 35 states have CON laws.
Ashley Bateman ([email protected]) writes from Alexandria, Virginia.
Office of Inspector General, U.S. Department of Health and Human Services, Hospice Deficiencies Pose Risk to Medicare Beneficiaries, July 2019:
Robert E. Moffit, Ph.D., “End-of-Life Care: Expanding Patient Choice of Ethical Options,” The Heritage Foundation, January 2019: