Weak hospice oversight makes safety problems hard to identify

Jun 28 2014

The typical hospice undergoes a full government inspection about once every six years, according to The Washington Post, making it one of the least scrutinized areas of U.S. health care. Meanwhile, more than three dozen hospices and health care groups are protesting a new rule designed to avoid duplicate payments for medications, saying it puts "undue burden" on dying patients.

The Washington Post: Is That Hospice Safe? Infrequent Inspections Mean It May Be Impossible To Know
The typical hospice in the United States undergoes a full government inspection about once every six years, according to federal figures, making it one of the least-scrutinized areas of U.S. health care -; even though about half of older Americans receive hospice care at the ends of their lives. By contrast, nursing homes are inspected about once a year, and home health agencies every three years. ... The nature of hospice care makes ensuring its quality difficult. Hospices typically send nurses and other personnel to a patient's residence -; whether at a private home, a nursing home or an assisted-living facility. The dispersal of patients makes oversight difficult to begin with, but the infrequency of inspections means shortcomings are even less likely to be detected (Whoriskey, 6/26). 

Reuters: New Drug Policy Too Burdensome, Hospices Say
The Centers for Medicare and Medicaid Services met Wednesday with 30 hospice and healthcare organizations after outcry over a new rule. The rule was designed to help avoid duplicate payments for hospice medications but may be having unintended consequences. More than 40 organizations called for the rule's suspension in a letter this week to CMS. Signed by the American Medical Association, the American Society of Clinical Oncology and the American Geriatrics Society, it argues the policy places "undue burden" on beneficiaries -- requiring "dying patients to navigate payer disputes" (Belisomo, 6/26).

Related KHN coverage: Medicare Seeks To Stop Overpayments For Hospice Patients' Drugs (Jaffe, 5/1).

Meanwhile, a columnist explains how hospice works -

Miami Herald: Ask Nancy: What You Should Know About Hospice Care
Q. My mother has been referred to hospice care for end-stage COPD (Chronic Obstructive Pulmonary Disease). I understand that prescription medications related to this condition are covered by Medicare hospice benefits. But what about the other medications that she currently takes for conditions including high cholesterol, elevated blood pressure and low thyroid. Will these continue to be covered under her Medicare prescription plan? Allison W., Jacksonville. A.I receive a lot of questions about hospice, so your question offers me an opportunity to provide a more detailed explanation about how hospice works (Stein, 6/26).