OIG nursing home report better than expected
Problems should be worked out collaboratively
In September the Office of Inspector General (OIG) in the Department of Health and Human Services (HHS) issued its long-awaited report on hospice care provided to nursing home residents. While this report identifies problems in such areas as frequency of visits, overlap between hospice and nursing home services, questionable hospice enrollments, and the current level of dual reimbursement, its critique is far less severe than the hospice industry had once anticipated.
In response to comments from the National Hospice Organization (NHO) and the Hospice Association of America to a draft report recommending that the hospice nursing home benefit be eliminated, OIG recommends instead that the Health Care Financing Administration (HCFA) collaborate with the nursing home and hospice industries to identify options for modifying the hospice nursing home benefit and payment structure so that coverage can be preserved for residents who truly need it.
"An underlying theme of the comments was a belief that it was inappropriate to recommend eliminating Medicare’s hospice benefit for patients living in nursing homes," OIG’s final report states. "However, there was general agreement on the need to examine Medicare and Medicaid payment for hospice patients living in nursing homes and to clarify the future role of nursing home staff in providing palliative care for patients with terminal diagnoses."
Some of OIG’s other findings are as follows:
- An estimated 17% of Medicare hospice patients in 1995 resided in nursing homes.
- One percent of all nursing home residents in 1996 elected the hospice benefit.
- Among nursing home hospice patients reviewed by OIG auditors, 16% were deemed ineligible for the Medicare hospice benefit at enrollment.
- Nursing home hospice patients received 46% fewer nursing and home health aide visits than their terminally ill counterparts living at home.
- Three-quarters of the patients received only nursing and aide visits from the hospice, and most of those services would have been provided by the nursing home anyway.
"This report reflects some of the same concerns NHO’s Board of Directors has about how hospice care has or has not been provided in nursing homes," says J. Donald Schumacher, PsyD, CEO of Hospice Association of Western New York in Cheektowaga, and chairman of NHO’s Nursing Home Task Force.
"It fits well with our task force’s direction, which is to put together some options for us to look at and ways to rectify benefit concerns. And it confirms that something needs to be done," he says. "Some people in our industry need to get clearer on what they’re providing in the nursing home."
"We support the report’s findings and recommendations for making improvements, and we have offered our services to help HHS and others improve the standard of care in this area," adds J.R. Williams, MD, chief patient care officer for Vitas Healthcare Corporation of Miami. "Personally I am skeptical that this kind of care can be done by one organization. It takes both. We are experts in hospice care, and the nursing home is expert in long-term care. Certainly there are things that need to be improved in this area, but it is key that the relationship for hospice care in the nursing home be a true partnership."
Next: Documentation and payments
NHO’s Nursing Home Task Force is now working on documentation issues and recommendations regarding payment structure. It plans a series of white papers with suggestions on how hospices can more appropriately provide this care, as well as "recommendations or discussion around some kind of certification or accreditation process for hospices generally and for nursing home care specifically," Schumacher adds. He hopes that the task force’s efforts eventually would be combined with HCFA’s work in this area, as recommended in the OIG report. "I think this is a really positive time for us to make the changes we know need to be made."
Meanwhile, HCFA has awarded a grant to the Urban Institute at Brown University in Providence, RI, and researcher Vince Mor, PhD, to study the current provision of hospice care in the nursing home, identify the next steps, and document what is value-added in this relationship, as well as the associated costs, Mor explains.
[To obtain copies of the OIG Final Report, Hospice Patients in Nursing Homes, OEI-05-95-00250, contact OIG’s public affairs office at (202) 619-1343. Or contact the OIG Web page at: www.sbaonline.sba. gov/ignet/internal/hhs/hhs.html.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content