OIG Releases Report on Hospice Care in Assisted Living

Last week, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) released a report on hospice care in assisted living. Titled “Medicare Hospices Have Financial Incentives To Provide Care In Assisted Living Facilities,” the report found, among other things, that Medicare payments for hospice care in assisted living more than doubled between 2007 and 2012, totaling $2.1 billion in 2012.

Also highlighted in the report was OIG’s finding that hospices provided care much longer and received much higher Medicare payments for beneficiaries in ALFs than for beneficiaries in other settings. Hospices typically provided fewer than five hours of visits and were paid about $1,100 per week for each beneficiary receiving routine home care in assisted living, according to the report.

Based on these and other findings, OIG makes the following recommendations:

  1. Reform payments to reduce the incentives for hospices to target beneficiaries with certain diagnoses and those likely to have long stays. One suggestion was to tie payment rates to beneficiaries’ needs.
  2. The Centers for Medicare & Medicaid Services (CMS) should target certain hospices for review, such as hospices that receive a high percentage of their payments from providing care to beneficiaries in ALF. OIG suggests that CMS include these measures in its Fraud Prevention System to identify hospices for further review.
  3. Develop and adopt claims-based measures of quality.
  4. Make hospice data publicly available for beneficiaries, similar to the way the agency does it for other providers (such as a Hospice Compare website).
  5. Provide additional information to hospices to educate them about how they compare to their peers. OIG recommends that CMS provide hospices with data on the percentage of beneficiaries in specific settings or with certain diagnoses, as well as the percentage of beneficiaries receiving higher levels of hospice care.

OIG notes in the report that the Centers for Medicare and Medicaid Services (CMS) has concurred with all five of its recommendations.  Read the entire report online.