The Centers for Medicare & Medicaid Services on Friday released long-awaited guidance for hospice surveyors that fundamentally transforms the survey process, according to a regulatory expert from LeadingAge.
“This is a complete overhaul of how surveyors are expected to survey hospices,” Katy Barnett, director, home care and hospice operations and policy, LeadingAge, told McKnight’s Home Care Daily Pulse on Monday.
The sprawling 196-page memo, which goes into effect immediately, provides detailed revisions to Appendix M of the State Operations Manual and CMS Hospice Basic Surveyor Training.
The meat of the guidance is the hospice survey’s new steps and process, Barnett said. CMS has added pre-interview and pre-survey requirements in which it is asking surveyors to review all the quality metrics available on Care Compare and also incorporate press reports as part of background information on a hospice. As an example of the latter, the news organization ProPublica did a report last year that found widespread fraud among for-profit hospices.
Another new addition in the guidance is a sampling strategy in which surveyors are expected to survey patients in three levels of care — inpatient, home care and continuing home care — as well as those who are live discharges. The sampling also includes surveying bereavement care, which is of particular significance to many nonprofit providers who have robust bereavement programs, Barnett noted.
“It’s one of the core benefits of hospice but not defined in the COPs [Conditions of Participation],” Barnett said. “[CMS is] looking to make sure all the services under hospices are being provided and in a comprehensive way. They are trying to dig deeper into patient and family care.”
Yet another new addition is a validation survey for a deemed survey. This allows CMS to investigate an accreditation organization that conducts a survey to make sure it is valid.
Friday’s guidance is a result of the Hospice Act of 2020. Hospices have been under the microscope in recent years, in part, because of several illegitimate hospices that have cropped up in states such as California and Texas. Earlier this month, four associations including LeadingAge, issued a call to CMS recommending legislative and regulatory changes to strengthen the integrity of the program. Among its recommendations were a moratorium on new hospices in high-volume regions and changes to the survey process.
The guidance is just the latest example of government oversight of hospices. A government report about the findings of the Technical Expert Panel on the Special Focus Program is due out in the spring.
Thanks to the guidance, hospices will have to change the way they prepare for surveys, Barnett said. The bright side of the guidance is it creates more consistency in the survey process.
“The is going in-depth on what surveyors are looking for so there is consistency from one surveyor to the next,” Barnett said.
Still, unlike home health, nursing homes and other healthcare settings, hospices are not accustomed to this new level of scrutiny.
“We’re getting more in lockstep with other settings,” Barnett said, adding, “It will be a big change for an industry focused on serving people at the end of life.”