Managing Survey and Litigation Risk in Hospice and Palliative Wound Care Alicia Jenkins, BS, RN, CWCN

Introduction

In hospice and palliative care, the primary goal is to provide comfort, dignity, and the highest quality of life for patients as they approach the end of life. Wound care is a critical component of this mission. Conditions such as pressure ulcers, venous leg ulcers, and malignant wounds are common among hospice patients and, if not properly managed, can lead to significant pain, infections, and a diminished quality of life for both patients and their caregivers.

However, many hospice organizations face challenges in delivering optimal wound care due to limited resources, lack of specialized expertise, and the complexities of regulatory compliance. Strict guidelines imposed by state surveys and Medicare demand meticulous wound care practices and documentation. Failure to meet these standards can result in severe penalties, including financial losses, reputational damage, and even litigation.

The Critical Role of Wound Care in Hospice Settings

Wounds are a prevalent issue in hospice care, affecting a significant number of patients. Studies indicate that up to 35% of hospice patients develop pressure injuries during their care (Edsberg et al., 2016). The complexity of these wounds is often exacerbated by factors such as advanced age, multiple health conditions, limited mobility, and poor nutrition—all of which hinder the healing process.

Effective wound care in hospice is not solely about healing wounds. Depending upon goals, the focus may be managing symptoms to enhance comfort and quality of life. This palliative approach focuses on stabilizing wounds, preventing new ones, controlling pain and odor, managing exudate, and preventing infections (McDonald, Lesage, & Couturier, 2017). It requires specialized knowledge and a compassionate, individualized approach tailored to each patient's unique needs and goals.

Challenges and Risks in Hospice Wound Care

Limited Resources and Expertise

Hospice organizations often operate with tight budgets and may lack access to certified wound care specialists. This scarcity can lead to inadequate wound assessments and management plans, negatively impacting patient outcomes and increasing the risk of complications (Whitney & Salvadalena, 2019).

Inconsistent Documentation and Compliance Issues

Accurate and consistent documentation is vital for effective wound care and regulatory compliance. Incomplete or inconsistent records can hinder communication among care teams and pose significant risks during state surveys and Medicare audits (Bolton, 2017). Documentation deficiencies are among the most common reasons for survey deficiencies, which can lead to penalties and impact an organization's standing.

Staff Turnover and Training Gaps

High staff turnover can result in knowledge gaps and inconsistent care practices. New, novice or temporary staff may not be fully trained in the latest wound care protocols, leading to variations in care quality and potential compliance issues (Black & Cuddigan, 2017). This inconsistency can increase the risk of survey deficiencies and expose the organization to litigation if standards of care are not met.

Staying Current with Best Practices

The field of wound care is continually evolving, with new treatments and evidence-based practices emerging regularly. Without dedicated wound care experts, hospice organizations may struggle to stay updated, potentially leading to outdated practices that fail to meet current regulatory standards and patient needs (NPIAP et al., 2019).

Regulatory Compliance, Survey Deficiencies, and Litigation Risks

Understanding Regulatory Requirements

State health departments and Medicare impose stringent regulations to ensure quality care in hospice settings. These regulations cover various aspects of wound care, including timely assessments, appropriate interventions, and thorough documentation (CMS, 2020). Compliance is mandatory for maintaining licensure, certification, and eligibility for reimbursement.

Hospice Outcomes and Patient Evaluation (HOPE)

CMS will initiate a new data collection requirement for hospice organizations beginning in October 2025. The “Hospice Outcomes and Patient Evaluation (HOPE) ” model is a comprehensive, real-time data collection tool developed by CMS to enhance patient care and reporting in hospice settings. Unlike its predecessor, the Hospice Item Set (HIS), HOPE collects patient-specific data at multiple time points, including admission, periodic updates, and discharge. This data helps inform and update care plans in real-time, ensuring that care is tailored to the patient’s changing needs.

By incorporating wound care data collection into the HOPE model, CMS will ensure that hospice providers can closely monitor and manage skin conditions as part of a patient’s overall care plan. The HOPE data set includes specific sections dedicated to identifying and documenting wounds such as pressure ulcers, non-pressure ulcers, and other skin issues. By collecting real-time data on wound status and treatments, hospices can ensure appropriate interventions are in place, contributing to improved patient comfort and quality of life.?

The HOPE initiative emphasizes that the provision of optimal skin care and the early identification and treatment of minor cases of Moisture-Associated Skin Damage (MASD) can help avoid progression and skin breakdown. Along with the shift towards value-based care, here we see a shift in healthcare from the common reactive stance—waiting for wounds to deteriorate and become complex before seeking expert intervention—to a proactive approach that encourages early referral for even minor conditions. By prioritizing timely management, we can avert the progression of skin issues, ultimately enhancing patient comfort and outcomes. This standardized approach aligns wound care with broader hospice goals, promoting comprehensive, patient-centered care.

Consequences of Non-Compliance

Failure to comply with regulatory requirements can have serious repercussions:

• Financial Penalties: Organizations may face substantial fines for deficiencies identified during surveys.
• Reimbursement Denials: Medicare may withhold or deny reimbursements, impacting the organization's financial stability.
• License Suspension or Revocation: Severe non-compliance can lead to the suspension or loss of operating licenses.
• Reputational Damage: Deficiencies can erode trust among patients, families, and the community.
• Litigation Risks: Non-compliance and substandard care can result in legal action from patients or their families, leading to costly settlements and further reputational harm.

Common Deficiencies Leading to Risks

Typical deficiencies related to wound care that can lead to survey citations and litigation include:

• Inadequate or delayed wound assessments.
• Ineffective or inappropriate treatment plans.
• Poor documentation practices failing to meet regulatory standards.
• Lack of interdisciplinary collaboration in care planning and execution.
• Failure to obtain informed consent when transitioning from curative to palliative wound care approaches (HPNA, 2014).

These issues compromise patient care and expose organizations to significant legal and financial risks.

Corstrata's Expertise: Mitigating Risks and Enhancing Care

About Corstrata

Corstrata specializes in providing expert wound and ostomy care services through innovative telehealth solutions. Our mission is to improve access to specialty wound care, delivering high-quality, cost-effective services nationwide.

Corstrata's team includes board-certified wound care specialists experienced in hospice and palliative care settings. We offer expert guidance on managing complex wounds, ensuring patients receive the most effective and compassionate care while aligning with their care goals.

Through telehealth technology, Corstrata provides timely wound care consultations, eliminating geographical barriers. This enables hospice staff to collaborate with wound care experts in real-time, facilitating prompt assessments and interventions that can significantly improve patient outcomes and compliance.

Staff Education and Training

Corstrata offers comprehensive education and training programs tailored to hospice organizations. These programs enhance staff competencies in wound assessment, treatment modalities, and documentation practices, reducing the risk of survey deficiencies and litigation.

Documentation and Compliance Support

Understanding the critical importance of documentation, Corstrata assists organizations in developing robust protocols that meet regulatory standards. We provide tools and templates to ensure consistent and complete record-keeping, mitigating compliance risks.

Benefits of Partnering with Corstrata

Enhanced Patient Outcomes and Comfort

By integrating Corstrata's expertise, hospices can improve healing rates, increase patient comfort and satisfaction, and provide personalized care that respects patients' wishes. Effective wound management reduces pain, odor, and other distressing symptoms, significantly enhancing quality of life.

Reduced Compliance and Litigation Risks

Corstrata's support helps hospices adhere to regulatory requirements, minimizing the risk of deficiencies during state surveys and Medicare audits. Our comprehensive approach ensures all aspects of wound care meet or exceed compliance standards, protecting organizations from penalties and legal action.

Empowered and Educated Staff

Staff members gain enhanced knowledge and skills through ongoing education, fostering confidence in managing complex wounds. Easy access to specialists encourages a collaborative environment, and standardized protocols promote consistency in care delivery.

Financial Stability and Cost Savings

By avoiding penalties associated with non-compliance and litigation, hospices can maintain financial stability. Efficient resource utilization through optimized care processes and prevention of complications reduces hospitalizations and associated costs.

Contact Corstrata

If your hospice organization seeks to improve its wound care program, ensure regulatory compliance, and reduce the risks of survey deficiencies and litigation, now is the time to act.

Contact Corstrata today for a consultation and discover how our expertise can transform your wound care practices.

• Email: [email protected]

References

1. National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP), & Pan Pacific Pressure Injury Alliance (PPPIA). (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Retrieved from NPIAP Website.
2. Centers for Medicare & Medicaid Services (CMS). (2020). Medicare and Medicaid Programs; Hospice Conditions of Participation. Retrieved from CMS Website.
3. American Academy of Hospice and Palliative Medicine (AAHPM). (2021). Palliative Wound Care: Principles and Practice. Retrieved from AAHPM Website .
4. Sibbald, R. G., Krasner, D. L., & Lutz, J. (2010). The SCALE skin changes at life's end: Final consensus statement. Advances in Skin & Wound Care, 23(5), 225-236.
5. Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system. Journal of Wound, Ostomy and Continence Nursing, 43(6), 585-597.
6. Hospice and Palliative Nurses Association (HPNA). (2014). HPNA Position Statement: Palliative Wound Care at the End of Life. Retrieved from HPNA Website .
7. McDonald, A., Lesage, P., & Couturier, Y. (2017). Palliative wound care: Holistic management of patients with chronic wounds at the end of life. Journal of Palliative Care, 32(2), 127-133.
8. Whitney, J. D., & Salvadalena, G. (2019). Nursing interventions for chronic wound management. Advances in Skin & Wound Care, 32(9), 409-419.
9. Black, J. M., & Cuddigan, J. E. (2017). National Pressure Ulcer Advisory Panel's updated pressure injury staging system. Dermatology Nursing, 29(4), 339-347.

Bolton, L. (2017). Managing risk and documentation to prevent malpractice lawsuits in wound care. Wounds, 29(2), 36-40.