Hospice - The time is now for additional integrity oversight

Hospice - The time is now for additional integrity oversight
JAMA Forum; by Joan M. Teno; 4/23
...Leading hospice organizations are calling for more oversight. The National Partnership for Healthcare and Hospice Innovation, LeadingAge, the National Association for Home Care & Hospice, and the National Hospice and Palliative Care Organization provided a comprehensive set of recommendations to preserve the integrity of hospice. These organizations are returning to the historic mission of hospice: to improve care for dying persons and support for their family members... The recommendations put forth by the 4 hospice organizations are important. Further reforms also are needed.

• First, transparency is necessary regarding who owns the hospice, especially involvement of private equity and organizational ownership arrangements that may create a conflict of interest. Efforts are needed to make sure the information is accurate.
• Second, the CMS should provide further explicit guidance on how hospice surveyors should use publicly reported data to select charts for review and determine which patients and family will receive in-person visits.
• Third, the use and accuracy of deemed status surveys (ie, when the CMS allows an accredited agency hired by the hospice program to conduct the survey) should be scrutinized through mandatory joint visits by federal surveyors and the deemed status surveyors that hospice programs hire and pay.

...Hospices are part of complex systems in which payment models allow flexible innovation, but concerns surface when some programs choose to focus on profits rather than care. The need for change is urgent to ensure that frail, older people receive high-quality care and that fraudulent care is rooted out of the system. Quality measures are important, but there is a need to improve integrity oversight. The time is now.
Publisher's note: Teno's article from 4/2023 recently came across my desk again and I was reminded how numerous hospice and palliative care leaders passionately advocated for additional integrity oversight. I find it interesting that CMS is now faced with several lawsuits about these same efforts.