Hospice benefit gets a break in OIG report
The Department of Health and Human Services Office of Inspector General (OIG) weakened its grip a little.
The OIG’s final report, Hospice Patients in Nursing Homes, pulls back from its first draft recommendation that the benefit be eliminated, instead urging that current rates be modified. Next month, we will present an analysis of this report and what it suggests about the future of the hospice nursing home benefit in an era of increased regulatory scrutiny and growing interest in rewriting the hospice benefit.
The stated purpose of OIG’s inquiry was "to examine eligibility, services, and growth in the number of hospice patients living in the nursing home." OIG audited 36 hospices mostly in the five original Operation Restore Trust states of California, Florida, Illinois, New York, and Texas and reviewed charts of more than 200 hospice patients residing in nursing homes in December 1995. Among its findings: Patients received 46% fewer hospice visits than patients living at home, while many of the hospice services overlapped with what the nursing home was doing.
Medical reviewers challenged the appropriateness of one out of six hospice admissions. The report also predicts continued growth in this sector all of which led to the conclusion that "current payment levels for hospice care in nursing homes may be excessive."
Comments on the first draft, from the National Hospice Organization, Hospice Association of America, and the Health Care Financing Administration (HCFA) challenged the need to eliminate the benefit altogether, while acknowledging that the nursing home benefit is more vulnerable to abuse and in need of some modifications. OIG recommends that HCFA, along with representatives from the hospice and nursing home industry, work to "develop additional options to preserve and enhance hospice care for those who need it when living in a nursing home."
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