OIG Report Raises Questions About Hospice Care at Assisted Living Facilities

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
OIG Report Raises Questions About Hospice Care at Assisted Living Facilities

A report published in January by the Health and Human Services Office of Inspector General (OIG) found that Medicare payments for hospice care in assisted living facilities more than doubled in five years. The report said hospices provided care much longer and received much higher Medicare payments for beneficiaries in assisted living facilities than for beneficiaries in other settings.

For example, hospices provided 98 days of care, on average, to beneficiaries in assisted living. That compares to 50 days for those in nursing facilities. Assisted living facilities received more than $16,000 per beneficiary, twice the amount for beneficiaries in nursing facilities.

OIG said the findings raise concerns that the current payment system may incent hospices to target beneficiaries in assisted living facilities because they offer hospices the greatest financial gain.

The report also questions whether beneficiaries in assisted living facilities are receiving the services they need during their last months of life. The study found that hospices typically provided fewer than five hours of visits per week, that the visits were mainly from aides rather than physicians, and that hospices seldom provided services on weekends.

In its report, OIG recommended the changes below. It’s worth noting that the Centers for Medicare & Medicaid (CMS) concurred with all five.

  1. Reform payments to reduce the incentive for hospices to target beneficiaries with certain diagnoses and those likely to have long stays.
  2. Target certain hospices for review.
  3. Develop and adopt claims-based measures of quality.
  4. Make hospice data publicly available for beneficiaries.
  5. Provide additional information to hospices to educate them about how they compare to their peers.

The full report, which is available online, contains OIGs complete recommendations and CMS’s responses. CMS’s letter mentions “the future development of the Hospice Quality Reporting Program” and says it will consider including claims-based measures such as average number of services, types of services, how often physician visits are provided and how often a hospice provides services on the weekend.

To learn more about how hospice organization can maintain regulatory compliance, download this e-book.

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