Mid adult female mental health professional takes notes as she talks with patient.

Hospices are already feeling the effects of new survey guidance the Centers for Medicare & Medicaid Services handed down at the end of January, according to the National Association for Home Care and Hospice. During a webinar Tuesday, NAHC leaders advised members to ramp their staff up quickly on the new steps and processing aimed at improving the quality of care to hospice patients.

“The changes were made because there is a concern that hospices are not delivering health services, that patients and their representatives may not understand hospice services and that the quality of services is not as expected,” Katie Wehri, NAHC’s director of home care and hospice regulatory affairs, told members during the webinar.

The refined hospice survey process focuses squarely on quality of care and prioritizes the surveyors’ time and attention on elements that affect the quality of care provided directly to patients and their families. Bereavement is receiving additional attention because some hospices were found to lack defined bereavement programs with services provided by the hospice.

“An initial bereavement assessment of the needs of the patient’s family and caregivers must be complete and timely,” advised Kim Skehan, director of compliance, regulatory and quality, at healthcare consultant SimiTree, during the webinar. “Information gathered from the initial brief must be incorporated into the hospice plan of care and considered in the bereavement plan of care.” 

Skehan also said hospice surveyors will be making sure that patients and families understand hospice election forms and the process of filing a complaint if they believe their family member did not receive appropriate care. 

The new guidance issued by CMS requires more research and investigation by surveyors during the pre-survey process. Wehri said it resulted from audits by the Department of Health and Human Services’ Inspector General in 2019 who found some hospices were not always providing necessary services to beneficiaries or were providing poor quality of care.

The new guidance also requires surveyors to review all quality metrics available on Care Compare and include any press reports as background information on a hospice. Last year, the investigative media site ProPublica published an article accusing some hospices of Medicare fraud by recruiting patients who were not near death or dumping those who had long hospice stays.