NHPCO Responds to New OIG Reports on Hospice Care

Categories: Opinion and Policy.

NHPCO welcomes the opportunity to shed a light on high quality providers as well as those that fall short in providing appropriate care. NHPCO will continue to partner with government agencies to strengthen and make more transparent the tools and data needed to empower consumers when they are choosing a quality hospice program. NHPCO will also continue to provide tools and resources to help our members to meet and exceed quality benchmarks.

On Tuesday, July 9, 2019, the Office of the Inspector General released two new reports following its investigation into hospice care in the U.S.  To briefly summarize, the OIG found that 20 percent of hospices have deficiencies that put patients at risk and the OIG is suggesting that among its recommendations that deficiency data be shared more broadly to help improve quality of care. The NHPCO health policy team is reviewing the recommendations in the OIG reports and will issue a Regulatory Alert to the membership later today.

News stories prompted by the OIG reports have been carried by The Washington Post, NBC News, and NPR. The journalists writing some of these news stories have shared selected patient stories based on their own investigation. These patient stories are difficult to read and reflect badly on hospice.  It is likely that other media outlets will carry these articles or generate additional news coverage on this topic.

Many of the issues brought up in the new reports have been discussed in previous OIG documents going back to 2005. NHPCO has addressed these issues in the past through resources that include: Regulatory tools and alerts, quality resources, NHPCO’s Compliance Certificate Program, our updated Standards of Practice for Hospice Programs, throughout our webinar offerings, at our conferences, in our podcast series, in staff presentations to the field, and in work done by our board committees.

NHPCO President and CEO Edo Banach would like to share some specific points with the field.

  • NHPCO has been and continues to be a champion for accountability and transparency within the hospice community and we have long supported additional oversight of the hospice program, including survey frequency now at every 36 months, appropriate data collection, compliance and quality resources, and availability of education and professional development offerings to the field.
  • Any hospice provider who fails to be fully compliant with all regulations and standards of practice and is unable or unwilling to provide the highest level of quality care should not be in the business of caring for the dying and their loved ones. The bottom line is that all hospices must ensure that every single patient receives care within all regulatory and statutory limits, that quality is never a question, and patient and family safety is never compromised.
  • Hospices in the U.S. care for nearly 1.5 million Medicare beneficiaries and their family caregivers every year (see NHPCO Facts and Figures Report). The OIG has released information that should serve to assist the Centers for Medicare and Medicaid Services in its efforts to provide appropriate oversight of the hospice provider community and NHPCO looks forward to working collaboratively on such efforts.
  • Extreme patient stories highlighted by the media that are not representative of the care most Americans receive can do more to frighten the public than inform them about the benefits of hospice care. NHPCO continues to stress that outliers in the field do not adequately reflect the vast majority of hospice care provision in the U.S.
  • NHPCO believes that incidents of deliberate fraud and abuse in the hospice field, though isolated, are indefensible. However, it is necessary to understand that rare incidents of deliberate fraud and abuse should be viewed separately from unintentional documentation or mathematical errors in an extraordinarily burdensome and complicated regulatory environment.
  • NHPCO looks forward to working with the Administration and Congress to simplify and streamline the hospice benefit and compliance process and to ease governmental red tape in order to encourage honest and law-abiding hospice providers while protecting the public from unacceptable intentional abuse. This includes better use of hospice data that CMS already obtains, educating CMS auditors, and to focus government efforts on abhorrent providers and spare compliant programs from needless and duplicative investigation.
  • As with previous reports from the Office of the Inspector General, NHPCO recognizes the value of some of the OIG recommendations and we welcome measures that will help hospices deliver patient- and family-centered care that meets the highest quality standards.
  • In media interviews, the OIG has clearly stated that they do not want to scare hospice patients and families away from hospice. Their focus is on quality of care and safety of patients and family caregivers, we share that with the OIG.

Finally, it should be understood that hospices have a sacred obligation to serve patients and family caregivers throughout the end of life journey. As the hospice care community – like the rest of America’s health care system – continues to evolve to meet patient and family needs, it is critical that government regulations also adapt and modernize to meet the needs of those served by this unique care model.

NHPCO offers information on finding and choosing a quality hospice in the consumer-focused section of its website, nhpco.org.

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