OIG targets hospice misuse of general inpatient care

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Hospices with their own inpatient units provided general inpatient care (GIP) to more Medicare beneficiaries, and for longer periods of time, than hospices without such facilities, an investigation by the U.S. Department of Health and Human Services Office of Inspector General found.

In fact, most of the $1.1 billion in GIP provided to Medicare beneficiaries in 2011 was provided by hospice inpatient units rather than by hospitals or skilled nursing facilities, the OIG found. One-third of the stays exceeded five days, and 11 percent lasted at least 10 days.

At the other end of the spectrum, 27 percent of Medicare hospices did not provide any general inpatient care to Medicare beneficiaries during the study period, OIG found. Additionally, according to the findings, 429 of 953 Medicare hospices provided no care other than routine home care.

The findings "raise several questions about GIP," OIG said.

Further review is needed to ensure hospices "are using GIP as intended and providing the appropriate level of care," according to the executive summary. OIG also recommended the Centers for Medicare & Medicaid Services ensure that hospices not providing GIP are providing appropriate care, noting one solution might be a CMS quality measure assessing hospices' ability to provide comprehensive hospice services.

The report noted CMS must reform the hospice payment system and develop quality measures under the Affordable Care Act. The two quality measures hospices must report beginning in 2014 relate to pain management and tracking of patient care.

As of 2011, one in four Medicare enrollees used hospice care, with Medicare-related hospice costs rising from $2.9 billion in 2000 to more than $12 billion in 2009.

In one case of questionable hospice billing practices, Alabama-based SouthernCare settled a whistleblower lawsuit for $24.7 million after it was found to have had some patients in hospice care for years, even though they did not appear to be terminally ill, FierceHealthFinance previously reported.

Meanwhile, hospice providers expressed concern last year that the average length of service for hospice patients was dropping, raising questions about whether patients were referred to hospices soon enough to take full advantages of their services.

To learn more:
- read the executive summary
- download the OIG report (.pdf)

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