Hospice Leaders Call for Overhaul of Regulation

Hospice News / By Holly Vossell

Hospice providers are calling on regulators to change their approaches to enforcement due to the cost burden and the unpredictable nature of the dying process.

The U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S Department of Health & Human Services Office of the Inspector General (OIG) have been cracking down on the industry with a heavy focus on patient eligibility and longer lengths of stay.

This has put hospices in a constant state of defense in today’s current regulatory climate, according to Craig Dresang, CEO of California-based YoloCares. 

“The reality is that we are in this posture of always being prepared to react and respond to the current auditing environment,” Dresang told Hospice News at the ELEVATE conference in Chicago. “We have to come together as providers with a fire and energy to insist on change from CMS, because we’re tired of playing a ‘gotcha game’ with the federal government. They’ve made the dying process a game of dates and deaths.”

Current rubrics for eligibility and length of stay are difficult to align with patients’ actual experiences at the end of life. A six-month terminal prognosis, for example, typically represents clinicians’ best guesses as to how long the patient will survive. But those predictions are not hard and fast.

This degree of unpredictability can make compliance challenging for providers, Dresang indicated.

Hospices also encounter variations in auditing practices that can impact perceptions of the provider’s performance, according to Alisa Gerke, executive director of Wisconsin-based Unity Hospice & Palliative Care.

“Some markets are set up whereby the auditor is incentivized in that the more issues they find, the bigger their paycheck,” Gerke told Hospice News during the conference. “We have to evolve and evaluate our practices and processes. We can’t afford not to have compliance more organized.”

The costs associated with these audits and other regulatory actions are high, according to Gerke.

In some cases, hospices can sometimes spend more on legal fees than they would make if the Medicare claims in question are ultimately paid, she explained.

To reduce the impact internally, hospice leaders need a system in place to identify high- and low-risk processes in terms of compliance, Gerke said. . .

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