Bloomberg Law
Nov. 14, 2019, 7:31 PM

For-Profit Hospices’ Care of Medicare Patients Questioned by GAO

Tony Pugh
Tony Pugh

For-profit hospice providers were more likely to discharge Medicare beneficiaries prior to their death and were less likely to visit these patients in the last three days of life.

The findings from a new Government Accountability Office report suggest a continuation of problems identified in previous reports on hospice care, which aims to improve the quality of life for patients with advanced incurable diseases.

For-profit hospice providers account for about two-thirds of all hospices compared to less than one-third in 2000. Medicare payment to hospices jumped from $2.8 billion in fiscal year 2000 to roughly $17.7 billion in FY 2017.

Researchers at GAO found “22.1 percent of beneficiaries served by for-profits being discharged alive compared to 12.0 percent of beneficiaries served by non-profits in 2017,” the report said.

A total of 462 for-profit hospice providers and 10 non-profits had high discharge rates of 50% or more, which could “be an indicator of poor quality of care or of provider misuse of the benefit, in that the hospice may be enrolling beneficiaries who are not eligible for hospice care,” the report found.

Additionally, for-profit hospices were more likely to not have staff, such as nurses and doctors, visit beneficiaries in their last 3 days of life, “a critical time in providing quality care, according to researchers GAO interviewed.”

No Nurse, Physician Visits

Research found 80 for-profits and 3 non-profits provided no visits in 2017 from registered nurses, physicians, or nurse practitioners in the beneficiaries’ last 3 days of life. “This means that all of the 800 hospice beneficiaries treated by these providers did not receive these types of provider visits at the end of life,” the report said.

In 2017, for-profit providers received $10.4 billion—or 58 percent—of the $17.9 billion that Medicare paid for hospice care. Non-profits received $7.2 billion, or 40 percent.

The Centers for Medicare & Medicaid Services should require state hospice inspections to incorporate more information about the providers’ performance on federal quality measures, the GAO report said.

Including more data—like whether a hospice provided staff visits during a Medicare beneficiary’s final week of life—could help identify potential quality-of-care problems, the Government Accountability Office wrote in a Nov. 14 report.

In a letter to the GAO, Sarah Arbes, HHS acting assistant secretary for legislation, said the agency agrees with the GAO recommendation.

“HHS recognizes that meaningful quality measures can also serve as key indicators of provider quality…We will looking into ways to incorporate the use of this meaningful quality measure data into the hospice survey process,” Arbes wrote.

Penalties Needed

“Congress should consider giving CMS authority to establish additional enforcement remedies for hospices that do not meet federal health and safety requirements,” the GAO report said.

Currently, CMS’ only option is to terminate a hospice provider from the Medicare program in instances of non-compliance with federal safety and health regulations. But that sanction is rarely used and typically reserved for hospice providers that don’t correct the most serious violations in a timely manner.

The GAO report says less-serious deficiencies could be subject to civil monetary penalties, much the way that home health agencies and nursing homes are sanctioned. But the CMS “lacks authority to impose such additional sanctions on hospices,” the report said.

To address the problem, Sens. Rob Portman (R-Ohio) and Ben Cardin (D-Md.) introduced the Hospice Care Improvement Act on Nov. 7.

In addition to publishing hospice inspection results for patients, the proposed legislation would increase the frequency of hospice inspections and establish additional penalties for non-compliant hospice providers similar to those faced by nursing homes and home health agencies.

In the House, Reps. Jimmy Panetta (D-Calif.), and Tom Reed (R-N.Y.) are working on companion legislation.

In testimony before the House Ways and Means Committee on Nov. 14, Edo Banach, president and CEO of the National Hospice and Palliative Care Organization, said “any provider that’s not fully committed to providing the best quality care should be in another line of business.”

To contact the reporter on this story: Tony Pugh in Washington at

To contact the editors responsible for this story: Fawn Johnson at; Andrew Childers at