Performance Improvement 2008. How Often Do States Survey and Certify Medicare Hospices; What Rate of Health Deficiencies Are Seen?


For Medicare hospices certified by State agencies, this study assessed whether the State-performed certification surveys were timely, what the surveys were, and the extent of the oversight by CMS of the Medicare hospice program. The study findings were based primarily on analysis of data from the CMS Online Survey Certification and Reporting system. Researchers analyzed these data for 2,537 hospices certified by State agencies and that were Medicare providers as of July 5, 2005. Researchers interviewed staff at CMS headquarters and regional offices, State agencies, and professional organizations knowledgeable about hospice issues. Medicare Part A covers hospice care provided to terminally ill patients. Organizations that provide hospice care must be certified by State agencies as meeting minimum participation standards prescribed by CMS. For fiscal year 2005, CMS scheduled hospice certification surveys for every 6 years, but for fiscal year 2006, CMS changed the frequency to every 8 years on average. Using the results of certification surveys and complaint investigations, CMS has the authority to apply only one enforcement remedy: termination of poorly performing hospices from Medicare.

Eighty-six percent of hospices were certified within 6 years, as required, while 14 percent averaged 3 years past due. Health deficiencies were cited for 46 percent of hospices surveyed and for 26 percent of hospices investigated for complaints; many deficiencies related to patient care. CMS and State agencies rarely used methods other than certification surveys and complaint investigations to monitor or enforce hospice performance.

Report Title: Medicare Hospices: Certification and Centers for Medicare & Medicaid Services Oversight,
Agency Sponsor: OS-OIG, Office of Inspector General
Federal Contact:
Claire Barnard, 202-205-9523
Performer: Office of Inspector General

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