Employees must complete the online survey form, answer the test questions. Marked checklist on a clipboard. Human resources and management concept

In a letter sent Wednesday, four U.S. representatives asked the Centers for Medicare & Medicaid Services to modify a proposed Special Focus Program (SFP) that has been criticized for potentially unfairly identifying “poor-performing” hospices.

The SFP, part of the proposed 2024 home health rule, would place these hospices under enhanced oversight and outline steps to ensure future compliance. In their letter, Reps. Earl Blumenauer (D-OR), Beth Van Duyne (R-TX), Jimmy Panetta (D-CA) and Brad Wenstrup (R-OH) echoed concerns that provider groups voiced in an August letter to CMS regarding the SFP. Their chief worry: The selection criteria to which hospices are subjected could, if finalized as proposed, put some providers at a disadvantage and fail to accurately identify poor performers.

“CMS’s proposed approach uses the raw number of hospices’ condition-level deficiencies (CLD) and substantiated complaint survey data to identify poor performers, which will disproportionately disadvantage larger facilities,” they wrote.

Other concerns include inadequate and outdated hospice survey data and the program’s heavy bias towards Hospice Care Index and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results for SFP determinations.

In response to the representatives’ letter, home care and hospice advocacy group LeadingAge applauded the legislators’ thoughts regarding the SFP.

“We, like the Congresspeople, support the intent of the program — to identify poor-performing hospices and create opportunities for quality improvement — but are concerned that the program as designed will not achieve those aims,” Mollie Gurian, vice president of home based and HCBS policy at LeadingAge, said in a statement sent to McKnight’s Home Care Daily Pulse. “We believe that SFP implementation must be developed with the proper algorithm to ensure the right programs are targeted and beneficiaries who refer to SFP-generated data are not misled as a result of inaccurate data.”

LeadingAge and the lawmakers noted that a technical expert panel was convened to develop a strategy for effective SFP implementation. The TEP pointed out that weighing CAHPS results so heavily could create “a perverse incentive for under-performing hospices to refrain from reporting CAHPS,” according to the congressional letter.

“We request CMS provide more transparency into why its proposed methodology for CAHPS data differed so drastically from that which the TEP recommended,” the congresspeople said.

LeadingAge concurred with the lawmakers’ recommendations to CMS, highlighting the need for stakeholder input during the development of the SFP. Both groups advised CMS to conduct a “dry run” of the SFP to help hospices and CMS alike better understand the program and inform future improvement.

“An effective SFP is critical to ensure beneficiaries have access to quality care,” Gurian said. “The letter underscores concerns that the proposed format of the program will not achieve these aims.”