From the U.S. Government Accountability Office, www.gao.gov Transcript for: Hospice Providers Oversight Description: In this episode, we're talking about federal oversight of hospice providers. Related GAO Work: GAO-20-10: Medicare Hospice Care: Opportunities Exist to Strengthen CMS Oversight of Hospice Providers Released: November 2019 [ Background Music ] [ James Cosgrove: ] More than 80 percent of families said that they were satisfied with the hospice that cared for their loved one, but we know that some hospices could do better. [ Matt Oldham: ] Welcome to GAO's Watchdog Report, your source for news and information from the US Government Accountability Office. I'm Matt Oldham. Medicare's hospice benefit provides palliative care to beneficiaries with terminal illnesses and a life expectancy of 6 months or less. And since 2000, a growth in Medicare payments for hospice services, and an increasing number of beneficiaries using hospice, has seen the growth in the number of hospice providers. There were approximately 4,500 in 2017. With me is James Cosgrove, a Health Care director, to talk about a GAO report on the Centers for Medicare and Medicaid Services' oversight of this hospice benefit. Thanks for joining me, James. [ James Cosgrove: ] Thanks for having me. [ Matt Oldham: ] So, more people are using hospice. It's costing more. And there are more providers. What did this report look at? [ James Cosgrove: ] As you noted, there's been phenomenal growth in the hospice industry since 2000, and much of that has been in the for-profit side. So we looked separately at both for-profit hospices and not for profit hospices. So one of the things that we did is we looked at some of the quality indicators that researchers have suggested are important, and we found some more variation there. One is the percent of beneficiaries who are discharged alive from a hospice. And you might think, well, you know that sounds like a good thing. And in some cases it is. It may be the beneficiary has improved in health status, or maybe the beneficiary has decided that they want more than palliative care. But it can also mean that a beneficiary is dissatisfied with the care that they've received from hospice and is leaving. And we found, for example, that there were almost 500 hospices -- virtually all of them for profit hospices -- where more than half the beneficiaries left at hospice while they were still alive. And we think that that's a group of hospices that you know probably CMS should investigate further. Another indicator is the visits at the end of life. I mean, this is a critical time for beneficiaries, and this is a time where hospices can provide emotional support. They can provide training about the dying process and what to look for, you know. But we found that there were over 80 hospices, again virtually all for-profits, where there were no visits from physician or nurses within the last three days of life. [ Matt Oldham: ] This isn't something that CMS is currently doing in their oversight role? [ James Cosgrove: ] You're right; they're not currently doing it right now. Their oversight, a large part of it has to do with inspections that are called surveys, and the surveyors go in and they see if the hospice is in compliance with federal health and safety requirements and they're looking for deficiencies. And if there's a major enough deficiency then the hospice might be terminated within 90 days. But we found a couple of important things one. One was that the surveyors before they go in, and look at a hospice, they do look at past surveys they look at complaints they might look at media reports but they don't look at quality indicators and we think that that's an important thing to do. They might want to know for example that there had been no visits at the end of life, because that's something that they could follow up on during a survey. Another finding we had was that CMS really has very few tools in its toolkit when it comes to remedies. It has one enforcement action, and that's to terminate the contract. That's a really extreme option. And you know this is in contrast to other types of providers where CMS has the authority to have other kinds of remedies that fall short of termination. [ Background Music ] [ Matt Oldham: ] So it sounds like this report found hundreds of hospice providers with more than half their beneficiaries discharging before death, and there were providers who had no medical staff visits to beneficiaries within the last few days of their life. So what were the recommendations from the report? [ James Cosgrove: ] Well we had recommendations both for CMS and for Congress. You know, for CMS it's, as you can expect, we think that they should incorporate additional information when they go out to do the surveys. So ,not only include information from the past surveys, but include information from the quality measures and to use that to also perhaps to help target hospices. For Congress, we think Congress should consider giving CMS the authority to have, establish, additional enforcement remedies so you know more than just terminating the contract that's something that falls short of that so that it can do a better job in overseeing and enforcing the quality standards. [ Matt Oldham: ] So last question James, what's the bottom line of this report? [ James Cosgrove: ] Well one thing I don't want to lose sight of is that more than 80 percent of families when they were surveyed said that they were satisfied with a hospice that cared for their loved one. But we know that some hospices could do better. So our report makes important recommendations that, if acted upon, could improve the oversight of hospices and lead to enhanced quality of care. [ Matt Oldham: ] James Cosgrove was talking about a GAO report on CMS oversight of hospice providers. Thank you for your time James. [ James Cosgrove: ] Thank you very much. [ Background Music ] [ Matt Oldham: ] And thank you for listening to the watchdog report. To hear more podcasts, subscribe to us on Apple podcasts. And make sure you leave a rating and a review to let others know about the work we're doing. For more from the Congressional Watchdog the US Government Accountability Office visit us at gao.gov.