Eli's Hospice Insider

Care planning-related deficiencies top surveyors’ lists.

The survey climate for hospices is getting worse, and that trend is only bound to intensify in the wake of the HHS Office of Inspector General’s latest reports on hospice surveys.

So indicates the OIG’s finding that the number of hospices with condition-level deficiencies nearly quadrupled from 2012 to 2015 — going from 74 to 292. And 20 percent (903 of 4,563) of hospices surveyed had at least one condition-level deficiency.

Other statistics the OIG reports reveal about the 2012 to 2016 period include:

• Eighty-seven percent of the 4,563 hospices surveyed in that period — nearly all participating providers — had a deficiency. Each year, 69 percent to 76 percent of surveyed hospices had at least one deficiency.
• Seventy percent (886 of 1,269) of the hospices that had a deficiency in 2016 also had at least one other deficiency in the five-year period.
• Less than 1 percent of hospices (28) had an immediate jeopardy citation.
• Fifty-nine percent of the hospices surveyed had deficiencies related to care planning. (For a list of top survey citations, see Appendix D of the report.)
• The OIG identified 313 hospices as “poor performers,” meaning they were surveyed and had at least one serious deficiency or one substantiated severe complaint in 2016.
• Poor performer hospices represent 18 percent of all hospices surveyed nationwide in 2016. They billed Medicare $1.6 billion for care provided to more than 135,000 beneficiaries that year.
• Texas, California, Missouri, and South Carolina had the highest numbers of poor performers.
• For-profit hospices account for a higher percentage of poor performers than nonprofits do at 67 percent, compared to 64 percent of all Medicare hospices. Nonprofit hospices account for 21 percent of the poor performers, and 23 percent of all Medicare hospices.
• One-third of hospices had complaints filed against them, and for almost half of these hospices, the complaints were categorized as “severe.” Thirty-two percent of the complaints filed against hospices in the five years were substantiated by surveyors, and 35 percent of severe complaints were substantiated.
• In each year, 11 to 14 percent of hospices had complaints filed against them. The most common complaints were about quality of care, patient’s rights, and administration issues.
• The number of hospices that had severe complaints filed against them grew each year, more than tripling from 78 to 285 from 2012 to 2016. “This increase may indicate a growing risk to an already vulnerable population,” the OIG warns.
• Vermont, Michigan, and North Carolina had the highest percentage of surveyed hospices with one or more deficiencies in the five-year period at 100 percent for Vermont and 99 percent for the other two states.
• States with the lowest percentage of surveyed hospices with one or more deficiencies in the five-year period were Maine (50 percent), Kentucky (54 percent), and Mississippi (59 percent).  (See Appendix C of the report for the breakdown by state.)

Source: Hospice Deficiencies Pose Risks to Medicare Beneficiaries (16 OEI-02-17-00020) at oig.hhs.gov/oei/reports/oei-02-17-00020.pdf.