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NY Times Article Exposes Chronic Understaffing in Nursing Homes

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services released a report last month pointing to extensive problems in the Medicare hospice program.

Hospice care continues to grow relentlessly in the U.S., with Medicare payments nearly doubling from $9.2 million in 2006 to $16.7 million in 2016. The growth in spending has far exceeded the growth in the number of beneficiaries and is not necessarily associated with more or better care.

The OIG report found several systemic problems with care, including failures to meet the care outlined in the patient careplan, incomplete careplans, and nonexistent physician visits - 3/4 of all beneficiaries never even see a hospice doctor.  Compounding this poor care is unreliable consumer information.  Beneficiaries and their families were found to be misled by the CMS Hospice Compare website that relies on bad and incomplete hospice provider data.

But no hospice report would be complete without detailing the massive overbilling and fraud that seems to go hand in hand with Medicare hospice, particularly in long term care settings.  The report detailed the typical hospice concerns: upcoding levels of care, double billing, and providing services to patients who are not actually terminally ill.  

But the report also features other, fresher concerns.  Some hospice companies are seeking beneficiaries in assisted living facilities or nursing homes because they generally need fewer services and have less complicated needs.  Hospices provide an average of only 41 minutes of service per day to beneficiaries in assisted living facilities, the majority of which comes from aides, at a cost of about $1,100 per week.  And even though care is needed seven days a week, 93 percent of care is given on weekdays.  Several for-profit hospice companies were identified as "focusing" or "targeting" assisted living or nursing homes.  No mention was made in the report that some hospice companies and long term care facilities share the same owners.

The report ended with several recommendations for improvement, including increased oversight of hospice in nursing homes and modification of payment plans for hospice care in nursing homes.  Reducing the rampant fraud in hospice care, however, seems extremely unlikely until real comprehensive payment reform occurs.

CLICK HERE to download the report (pdf).