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NHPCO Working to Help Hospices With Compliance for Hospice Patients in Nursing Homes

OIG Report Indicates Attention to Compliance Issues is Necessary

ALEXANDRIA, Va., Sept. 10 /PRNewswire-USNewswire/ -- Yesterday, the Department of Health and Human Services Office of the Inspector General issued the final two reports in a series of four, which reviewed the hospice benefit for residents of nursing facilities. The report indicated that 82 percent of the 470 claims that were part of the study did not meet at least one Medicare coverage requirement for hospice services. Among the OIG's recommendations were increased hospice provider education, tools fostering better compliance, and strengthened monitoring of practices, such as medical review and additional surveys.

The National Hospice and Palliative Care Organization supports the OIG recommendations.

"This report provides hospices with information that will improve care processes for hospice patients residing in nursing facilities. NHPCO is committed to helping providers reach full compliance with this, and all, regulatory issues," said J. Donald Schumacher, NHPCO president and CEO. "It's important to remember that the study provides a helpful review of claim forms and should not necessarily be cause for concern for people receiving hospice care in a nursing facility at this time."

The study, using a sample of 470 claim forms from 2006, highlighted technical compliance issues with the medical record that included form that did not meet election requirements (33 percent), issues relating to plan of care requirements (63 percent), and hospices providing fewer services than outlined in the beneficiaries' plans of care (31 percent).

Joan M. Teno, M.D., MS, Professor of Community Health and Medicine Warren Alpert School of Medicine of Brown University, and a hospice medical director, added, "More hospices are adopting electronic medical records (EMRs) that will improve the documentation and compliance. Furthermore, while these measures provide evidence of 'paper compliance' - an even more important measure of the quality of care are the viewpoints of bereaved family members on the quality of hospice care. "

NHPCO gathers data on the quality of hospice care from bereaved family members through a post-death evaluation of care survey and added a question about hospice care in nursing homes in 2008. Of the just over 30,000 family members who indicated that their patient was in a nursing home under hospice care, over 19,000 said that the care improved for their loved one after hospice became involved and slightly over two-thirds rated the quality of hospice care provided in the nursing home as excellent.

In addition to the recommendations in this report, in a previous report, the OIG also recommended the value of increased on-site survey frequency. NHPCO strongly supports this recommendation as well.

New hospice regulations were published in June 2008 and extensive training and educational offerings were offered, in cooperation with CMS. NHPCO has developed resources, tools and sample forms for providers to strengthen compliance with the new regulations and to assist providers in understanding compliance.

"NHPCO looks forward to working with CMS and the broader hospice community to increase compliance - which is an ongoing collaborative effort," said Schumacher. "We have developed resource materials and tools that providers can access today that will help improve compliance and provide examples of excellence in care."

The hospice community continues its long standing tradition and practice of intolerance for non-compliance practices, support for enhanced regulatory scrutiny - both from more frequent surveys and from medical review - and transparency in the provision of care and operations of hospice programs.

Note: the OIG reports are available online at

    Jon Radulovic
    NHPCO Vice President of Communications
    Ph: 703-837-3139 

NHPCO is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO's mission is to lead and mobilize social change for improved care at the end of life,

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J. Donald Schumacher, PsyD

SOURCE National Hospice and Palliative Care Organization
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