Healthcare

Medicare’s Oversight Of Hospices Are Failing, Inspector General Report Says

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The majority of hospices that participate in Medicare had “one or more deficiencies” in quality of care between 2012 and 2016, including claims of maggots and uncontrolled pain, according to an inspector-general report (OIG).

Almost 20% of hospices inspected in 2016 had a major deficiency or a proven serious complaint, WaPo reported, making them “poor performers.” Skipping home visits, not assessing pain amounts of patients, and maggots around the opening of a wound were detailed in the report.

“Some Medicare beneficiaries were seriously harmed when hospices provided poor care or failed to take action in cases of abuse,” OIG reported.

In one case, a patient developed gangrene from pressure ulcers and had to have an amputation. In another, a patient allegedly suffered injuries from a sexual assault that were missed, and a third instance detailed a patient who didn’t get the correct medication and died painfully, WaPo reported.

A man in hospice care was discovered by his family to have “maggots around the opening of his wound” in another case.

“CMS [Centers for Medicare and Medicaid Services] has zero tolerance for abuse and mistreatment of any patient, and CMS requires that every Medicare-certified hospice meet basic federal health and safety standards to keep patients safe,” a CMS spokesperson who requested to be on background told the Daily Caller News Foundation in response to the OIG survey.

“The OIG’s findings are based on cases that occurred between 2012 and 2016, a selective sample of the most serious cases of harm found during hospice surveys. In these cases, CMS cited the hospices for failing to meet certain requirements in the Medicare and/or Medicaid programs.”

Patients with Medicare are also limited in what they can screen for quality by themselves as well as having a limited ability to make complaints, according to WaPo.

Medicare also can’t give out fines for “poor performers,” according to the report.

“Based in part on these findings from 2016 and before, CMS is laser-focused on improving its oversight of healthcare facilities, including hospices,” a CMS spokesperson said. “Just this year, CMS issued new guidance to surveyors — who inspect hospices and other facilities — to help them more quickly identify and address the most grave patient safety situations, called ‘immediate jeopardy.'”

“CMS is always ensuring the maximum transparency possible regarding the findings from safety inspections at all healthcare facilities,” the CMS spokesperson continued. “CMS is making hospice quality information easier for consumers to find and understand on our Hospice Compare website. We appreciate the OIG’s review and will work with it as we continue to strengthen CMS’ oversight and enforcement efforts to address and prevent harm.”

A patient has to be terminally ill with a life expectancy of less than six months in order to qualify for hospice care under Medicare. Coverage will continue if the patient lives longer than six months, and Medicare pays hospices between $200 and $150 a day depending on how long the patient has been in care, WaPo reported.