Terminally ill patient hooked up to machine receives lifesaving care at home

Better training, consumer-friendly reporting and fairer non-compliance penalties are some of the recommendations the National Hospice and Palliative Care Organization (NHPCO) has sent to the Centers for Medicare and Medicaid Services on hospice survey reform.

The reforms are part of CMS’ proposed home health rules for 2022 and lay out a number of changes in the way hospice agencies will be surveyed. They follow a 2019 Health and Human Services Department Office of Inspector General report that found 80% of hospices surveyed had at least one deficiency, while 20% had at least one serious deficiency.

Headshot of Edo Banach
Edo Banach

“For the most part it reflected a lot of our feedback already and we are thankful for that,” NHPCO President and CEO Edo Banach told McKnight’s Home Care Daily.

Still, NHPCO is seeking a laundry list of tweaks it wants CMS to make before it finalizes the survey rule. Banach said the top priority is ensuring that surveyor training is consistent across all 50 states and that surveyors have knowledge of the hospice industry.

“You have a lot of real-time education going on between the provider and the surveyor which shouldn’t happen,” he said. “It should happen the other way around. The surveyor is there to say these are the rules and abide by them. They shouldn’t be educated on the fly, on the job by the provider.”

NHPCO is also recommending CMS appoint a technical expert panel to help design and implement the surveys. Banach said that the panel should include a consumer representative and all reports stemming from surveys should be written in ways that are consumer-friendly.

“If we can come out with a standard way consumers can see surveys and standard graphics, I think that would be helpful to consumers,” Banach explained.

NHPCO is also seeking a change in the way CMS would penalize a hospice for non-compliance. Banach said the proposed penalty is much too severe for an agency that is receiving a “slap on the wrist” for a deficiency.

“CMS can say you don’t get to admit anybody, you can’t bill for anybody and you’re basically out of business,” Banach said. “What we’re saying is that it’s really not a slap on the wrist that the government is going for; it’s an immediate jeopardy situation — something that is severe — and the ban should be on new admissions going forward, not necessarily going back.”

NHPCO filed its comments to CMS last Friday. Banach said it would continue to work the agency toward the final rule.