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Ensuring care quality a challenge for HHS, OIG says

November 18, 2014
by Lois A. Bowers, Senior Editor
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Ensuring care quality in nursing home and hospice settings as well as via home- and community-based services (HCBS) is one of the top challenges facing the U.S. Department of Health and Human Services (HHS), according to a new report from the HHS Office of Inspector General (OIG).

“OIG continues to identify various problems with nursing home and hospice care,” the report notes. “For example, in reports on nursing homes, OIG raised concerns about the frequency of preventable adverse events due to substandard care, the extent to which nursing homes comply with federal regulations for reporting abuse and neglect, and the lack of monitoring of nursing homes' resident hospitalization rates. With respect to hospice care, OIG has raised concerns about insufficient monitoring of hospice service use, as well as inadequate oversight of hospice certification surveys and hospice-worker licensure requirements.”

The report lists several ways in which HHS is addressing the challenge and also makes recommendations on ways that HHS can further efforts related to ensuring care quality:

  • Monitor how often nursing home residents are hospitalized.
  • Develop resources that can be used to help nursing home staff reduce the incidence of adverse events in nursing homes.
  • Seek to link payments for services to meeting quality-of-care requirements.
  • Work with OIG to hold accountable those providers that have rendered substandard care, thereby preventing additional harm to vulnerable beneficiaries.
  • Promulgate the regulations mandated under section 6102 of the Affordable Care Act concerning compliance and ethics programs for nursing homes.
  • Use tools provided under the Protecting Access to Medicare Act (PAMA) of 2014 and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 to improve the quality of care provided by nursing homes and other post-acute care providers. Under PAMA, high-performing providers in a value-based payment program can receive incentive payments. Under IMPACT, providers must meet new reporting requirements  related to standardized admission and discharge patient assessments. Also, hospice programs must be surveyed at least once every 36 months.
  • Ensure the integrity of Medicaid-funded personal care services by establishing minimum federal qualification standards for providers; improving federal and state government ability to monitor billing and care quality; and issuing operational guidance for claims documentation, beneficiary assessments, plans of care and supervision of personal care attendants.
  • Issue guidance to states regarding adequate prepayment controls, and help states access data necessary to identify overpayments related to Medicaid-funded personal care services.

Nursing homes, hospices and HCBS providers that deliver substandard care will continue to face enforcement action through the Department of Justice, the federal Elder Justice Interagency Working Group and state Medicaid Fraud Control Units, the report notes. Rather than close a nursing home or withhold federal funding from beneficiaries living in a particular facility, the OIG prefers to address issues through corporate integrity agreements, when possible; so far, such agreements have been arranged with more than 750 facilities run by 40 nursing home companies, the authors add.

To see all 10 challenges facing the HHS, according to the OIG, access the entire report.