Hospice agencies must subject themselves to government inspections at least once every three years under new legislation approved by Congress, part of a measure that addresses concerns about substandard operators in the booming industry.
Approved by the House earlier this week and by the Senate late Thursday night, the bill also requires closer scrutiny of hospices at which a large percentage of patients live longer than six months — a sign to regulators that a hospice may be intentionally enrolling people who are more profitable than patients closer to death.
As the hospice industry has grown in recent decades, evolving from a movement of nonprofit organizations into a significant piece of the health-care industry, critics have noted that some of the new hospices may not be living up to the original ideals.
Several Medicare statistics analyzed by The Post indicate that some hospices may be stinting on patient care in order to pad profits.
For example, about 18 percent did not provide a single patient with “crisis care” during 2012, according to Medicare billings analyzed by The Post, meaning the hospice did not provide either continuous nursing care or inpatient treatments. Hospices are required to provide such services to patients whose symptoms are difficult to control.
The legislation, which is expected to be signed by President Obama, takes aim at two problems in the industry, which gets most of its revenue from Medicare, the federal program that pays for the medical care of the nation’s seniors.
The first is the infrequency of inspections, which allows substandard operators to stay in business. In recent years, inspections have been held about once every six years or more, at least partly due to budget constraints. The added cost to the government of more frequent inspections is less than $6 million annually.
“Currently, hospices can go eight years or more without ever being surveyed, which is far too long,” J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, a trade group, said in a statement. “More consistent surveys, and the process providers go through to prepare for them, will help hospices and ultimately benefit the patients and families in their care.”
Measures that would increase the frequency of hospice inspections have been introduced every year starting more than three years ago. But despite urging from some industry leaders, Congress did not act and the inspection schedule remained sparse.
“This will bring hospices up to the standards of the health-care industry,” said hospice veteran Christy Whitney, chief executive of HopeWest hospice in Colorado, a large nonprofit serving western Colorado. “I really believe that a lot of the issues that have been exposed can be prevented by this. It won’t just catch bad actors. It will make well-intended hospices better, too.”
The legislation also takes aim at hospices that appear to be enrolling patients even though they are not near death. These patients generally are easier to care for and are more profitable. The legislation calls for closer scrutiny of hospices at which a large portion of patients live longer than six months.
The hospice provisions were part of a broader bill that seeks to more closely monitor care for the elderly after they get out of the hospital and into facilities for nursing, rehabilitation and long-term care.
“This bill is a critical first step toward strengthening Medicare’s oversight of hospice services,” said Sen. Ron Wyden, D-Ore., one of the bill’s primary authors. “I am very pleased that Medicare will now have the resources to review hospices and ensure they are providing quality care. I look forward to continue working with my colleagues in a bipartisan fashion to improve Medicare hospice services.”
“This bill is critical to driving fundamental reform of care for seniors after a hospitalization,” added Rep. Dave Camp (R-Mich.), chairman of the House Ways and Means Committee, in a statement. “It represents the beginning of a much larger conversation. We owe it to our seniors to ensure the Medicare program is able to provide the seamless care that we all expect.”