Medicare Home Health Agencies: Weaknesses in Federal and State Oversight Mask Potential Quality Issues

摘要

Home health agencies (HHA) play an important role in the U.S. health care system-allowing individuals who are unable to leave home without great difficulty to receive certain medical or therapeutic care in their own homes. In December 2000, the Congress directed that we assess quality-related aspects of HHAs, including the operation of branch offices. To do so, we addressed four questions: (1) what is known about the quality of care provided by HHAs, (2) is the current survey process adequate to identify quality-of-care problems at both parent and branch offices, (3) are state investigations of complaints made against HHAs effective in protecting patients, and (4) is federal oversight of state survey activities and enforcement efforts adequate. To answer these questions, we analyzed information from the On-Line Survey, Certification, and Reporting system (OSCAR), a federal database that tracks the results of state HHA surveys; visited survey agencies in California and Texas, states with the largest numbers of HHAs; surveyed 12 additional states in order to evaluate their survey and complaint processes; reviewed a sample of 96 survey reports from the 34 states that cited deficiencies in certain quality-related conditions of participations or associated standards; and reviewed a sample of 93 complaints from our 14-state sample. We also interviewed officials at the Centers for Medicare and Medicaid Services (CMS), an agency within the Department of Health and Human Services, and surveyed CMS's 10 regional offices about inspection requirements and federal oversight activities. CMS administers Medicare and oversees the contracts with state survey agencies. We reviewed statutory requirements and CMS regulations regarding HHA surveys. We performed our work from January 2001 through June 2002 in accordance with generally accepted government auditing standards. (App. I presents a detailed discussion of our scope and methodology.)