Hospice Advocacy Groups Call on CMS to Delay, Revise Special Focus Program

A coalition of industry groups has spoken out about the design of the U.S. Centers for Medicare & Medicaid Services (CMS) forthcoming Special Focus Program (SFP) for hospices.

CMS initially pitched the idea in 2022 but instead convened a Technical Expert Panel (TEP) to further guide development. The TEP completed its work late last year, and now, per the 2024 proposed home health rule, the agency wants to move ahead with it next year.

Meanwhile, four hospice advocacy organizations have reached out to CMS with questions and recommendations for designing the program that would ostensibly address the agency’s concerns while ensuring that any screening for the SFP is conducted fairly and equitably.

“As an industry, we are committed to providing quality, patient- and family-centered care and want the SFP to succeed in helping struggling hospices improve the care they are providing,” the organizations wrote in a letter to CMS. “Unfortunately, as proposed, it would likely identify providers that are not the most appropriate candidates, while missing hospices that actually need additional support to address quality shortcomings.”

The letter was signed by the National Hospice and Palliative Care Organization (NHPCO), the National Association for Home Care & Hospice (NAHC), the National Partnership for Healthcare and Hospice Innovation (NPHI) and LeadingAge.

If designed similarly to those used in other settings, the SFP would have the power to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys. Hospices flagged by the SFP would be surveyed every six months rather than the current three-year cycle.

The program would have the authority to impose fines, suspend reimbursement, appoint temporary management to bring the hospice into compliance or revoke a provider’s Medicare certification altogether.

The four organizations’ concerns focus on the quality indicators that CMS chose to apply and would not effectively identify the hospices most in need of the program, the letter indicated.

“We have concerns that the quality indicators identified in the proposed CY 2024 Home Health rule will not fully identify all hospices at high risk of delivering poor-quality care and may also result in hospices that take care of large numbers of patients being disproportionately and unfairly categorized as poor-performers merely as a result of their size,” they wrote in the letter.

The SFP was among the requirements established by the Consolidated Appropriations Act of 2021.

Congress included the hospice language in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS). CMS expects that implementing these proposals would cost an estimated $5.5 million annually.

Among other recommendations, the groups proposed that CMS further delay the implementation of the SFP and that the agency issue a new proposed rule that would contain a modified algorithm

“This would help providers understand the algorithm and where they need to target improvements to ensure high-quality care,” the organizations indicated. “It would also provide more time to refine the algorithm to be sure the program is capturing an appropriate subset of hospices. The consequences of being selected for the SFP are severe, which is why the selection criteria must be designed to identify the subset of hospices that are most in need of remediation to address quality concerns.”