Home Health & Hospice

OIG recommends more frequent hospice recertification surveys

Homecare Insider, September 9, 2013


In a recent memo to Marilyn Tavenner, Administrator of the Centers for Medicare & Medicaid Services (CMS), the Office of the Inspector General (OIG) recommends increasing the frequency of hospice recertification surveys.

According to the OIG, the memorandum report follows up on an unimplemented recommendation regarding the frequency of hospice recertification surveys conducted by ttate survey agencies to ensure compliance with Medicare Conditions of Participation (CoPs).

In the 2007 Office of Inspector General (OIG) report Medicare Hospices: Certification and Centers for Medicare & Medicaid Services Oversight, the OIG found that the most recent recertification survey for 14% of state-surveyed hospices had occurred more than six years before the index date of July 5, 2005, with the length of time between the most recent survey and the index date averaging nine years. Further, when surveys did occur, 46% of the surveyed hospices received citations for health care deficiencies, with the most frequently cited deficiencies related to care planning and quality issues.

The OIG recommended that CMS seek statutory or regulatory timeframes for the frequency of hospice recertification surveys by State survey agencies and suggested a timeframe of three years. CMS did not concur with the recommendation, indicating that conducting more frequent surveys would require congressional action to allocate additional resources.

To determine whether the frequency of hospice recertification surveys had changed since the prior report, the OIG compared current survey frequencies to the prior findings.

The OIG found that the frequency of recertification surveys had not improved since 2005. As of the index date of February 28, 2013, 17% of state-surveyed hospices had not been recertified within the preceding six years, with some hospices experiencing longer intervals since their most recent survey. This finding confirms that the frequency for recertification surveys has not improved since 2005, when 14% of hospices had not been surveyed in 6 years. The OIG also found that in 12 states, more than 25% of hospices had not been recertified within the last 6 years. These findings suggest that CMS’s use of fluctuating annual targets does not ensure timely recertification surveys of all hospices and  also raise concerns about whether CMS and contracted state survey agencies can ensure that hospices comply with Medicare CoPs and quality-of-care requirements for hospices.

Click here to read the full memo.