NHPCO Responds to OIG Report

To:       NHPCO Membership
From:   Edo Banach, President and CEO

Date:   July 31, 2018

As many of you may be aware, the Office of the Inspector General has released a portfolio report, “Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity,” focusing on concerns with the Medicare hospice benefit. NPR’s Morning Edition and Kaiser Health News (which concludes with some important quotes I offered before the report was released) both did pieces on the report that I’m sure some of you have read or heard this morning.

Let me stress that many of the issues brought up in the new report have been discussed in previous OIG documents. NHPCO has addressed these issues in regulatory alerts and resources, on our Webinars, at our conferences, in staff presentations to the field, in our Regulatory Podcasts, and explored by our board committees. So, I hope the contents of the report do not come as a complete surprise and cause you to be too discouraged.

Let me offer some additional comments and context in response to this OIG report.

• NHPCO recognizes the value of some of the OIG recommendations and we welcome measures that will help hospices focus on value over volume and patients over paperwork.
• However, NHPCO continues to stress that outliers cited in the report do not adequately reflect the context of hospice care provision in the U.S.
• Importantly, CMS rejects over half of the OIG’s hospice recommendations, and we generally agree.

We believe that incidents of deliberate fraud and abuse in the hospice field, though rare and isolated, are indefensible. For this reason, NHPCO has been and continues to be a champion for accountability and transparency within the hospice community. And we look to our members to be our partners in this important work.

Furthermore, it is necessary to understand that rare incidents of deliberate fraud and abuse should be viewed separately from unintentional documentation or mathematical errors in an extraordinarily burdensome and complicated regulatory environment.

We look forward to working with the Administration to simplify and streamline the hospice benefit and compliance process and to ease the governmental red tape in order to encourage honest and law-abiding hospice providers while protecting the public from unacceptable intentional abuse. This includes better use of hospice data that CMS already obtains and to focus government efforts on truly abhorrent providers and spare compliant programs from needless and duplicative investigation.

NHPCO encourages the OIG and CMS to examine ways in which the current structure of the benefit can prevent patients and families from accessing medically necessary care and subject them instead to more costly and less beneficiary-friendly environments. Also important to examine is underutilization of hospice care. As reported in our annual Facts and Figures Report, 28 percent of beneficiaries received care for only seven days or less in 2016. Like intentional fraud, this is unacceptable.

Hospices have a sacred obligation to serve patients and family caregivers throughout the end of life journey. As the hospice care community – like the rest of America’s health care system – continues to evolve to meet patient and family needs, it is critical that government regulations also adapt and modernize to meet the needs of those served by this unique care model. Let us work with the OIG, CMS, and Congress to build on our 35 years of experience with the Medicare hospice benefit to seek solutions in caring for people facing serious and life-limiting illness.