On May 13, we wrote about the CMS moratorium and the conversations it was already changing for hospice liaisons and intake teams. The headlines have certainly not quieted down since the moratorium was announced, both within the hospice community and the broader (more salacious) reports on local and national news outlets.
Talking with hospice leaders since the moratorium was announced, we have heard a few versions of the same questions come up across very different organizations: Should we keep our heads down? Should we pull back our business development team while the dust settles?
We understand the instinct, and it feels both prudent and safe. We also think it’s exactly the wrong move for a compliant high-quality provider. Of course, each provider’s circumstance is different and Transcend always recommends checking with your legal and compliance teams to establish your comfort level with growth practices.
The fraud conversation and the policy conversation are two wholly separate issues.
What CMS has named publicly, with addresses and dollar figures attached, is concentrated and highly questionable activity. The provider community broadly agrees that there needs to be scrutiny in some areas. The 773 hospices in Los Angeles. The clustered patterns in a handful of metros where dozens of agencies share owners, addresses or beneficiary populations. Those are the cases that produced the moratorium, whether you agree with CMS’ specific approach to the situation or not.
Running alongside that, but separate from it, is a broader policy conversation about hospice utilization, which has been increasing with the growth of the Medicare Hospice Benefit itself. Length of stay, live discharge rates, cap exposure, MedPAC’s commentary: All of these are healthy policy discussions for a benefit that serves millions of Medicare beneficiaries each year and is increasing as a share of Medicare spend. Those conversations have been ongoing for years, and they are about overall hospice benefit structure. Quality providers of all tax statuses and sizes are very much part of that conversation, and the standards being shaped through it will define what compliant, mission-driven hospice care looks like for the next decade.
For an established provider, conflating the two issues negatively impacts the hospice movement and the need for end-of-life services. Seriously ill patients still need hospice services, and underutilization of the benefit has not changed.
Transcend believes the instinct to clamp down is well-intended but strongly cautions against it.
When actions like this happen, the temptation by providers can be to keep a low profile and adopt a conservative approach to community engagement. In our conversations since the moratorium was announced, we have already heard examples of this happening.
If your clinical, compliance and quality practices are sound, we believe the answer is not to slow down. It is to sharpen your approach to the market.
We are counseling clients to consider leveraging the following tools in the wake of the moratorium announcement:
- Referral source education. Here’s an uncomfortable truth: Most physicians and discharge planners have less understanding than we as providers would like about compliant hospice practice. They may struggle to tell much difference between a fraudulent paper hospice in another state and the quality provider they have worked with for decades. They are reading the same headlines your patients’ families are reading. Your liaisons should be teaching as much as selling in every conversation this quarter. Educate on accreditation status, your latest survey results, how long you’ve been submitting quality information, and your compliance program.
- Compliance training as a part of regular operational rhythm. Now is not the time for a one-time recorded video training. A standing rhythm of case review, scenario walkthroughs and team-wide conversations are what the moment calls for. The agencies we work with that handle scrutiny well are the ones where compliance is part of the operating culture rather than an annual training event.
- Documentation rigor. The clinical picture of your referrals has not changed since May 13. The standard for documenting their eligibility is always worth examining and improving.
- Clear escalation pathways. Every staff member, clinical or non-clinical, should know exactly how to raise or escalate concerns or questions they have about how your agency approaches growth and sustainability.
Those are the levers that belong in your hand right now, not simply tightening criteria and potentially leaving dying patients without the pain and symptom management hospice can provide.
The patient advocacy imperative.
The most important thing quality providers can do in this moment is educate on what good hospice practice looks like. Do it now, do it publicly, and do it often.
If we as a community don’t define what good care looks like, the media and CMS’s next round of regulatory language will. Families in crisis, the ones making the hardest decision of their lives in a hospital hallway or a kitchen at midnight, will pay the price. They will hesitate to elect. They will delay. They will arrive on service with two weeks to live when they could have had six months of relief.
This is not abstract. The headlines are already sowing confusion. Liaisons are reporting more pushback from families. Discharge planners are asking more careful questions. Some of that scrutiny is healthy, and the sector will be better for it. Some of it is going to keep patients from getting good care unless quality providers fill the vacuum with their own voice.
That means writing, speaking, posting and holding referral source education sessions that don’t pull punches on the fraud question. It means sitting on panels at the local hospital association and being the agency in your market that the trusted reporter calls when they need a clinician to explain what hospice actually is. It also means putting the story of your own compliance posture, your own clinical rigor, and your own quality metrics in front of the people who need to hear it. Quietly humble does not serve patients well right now; being confident, specific and educational does.
Where to focus.
If we had to compress the next six months of operating posture into a single strategic recommendation, it would be this – tighten what’s internal and amplify what’s external. Document with specificity. Train more often. Escalate concerns faster. And then go out and tell the truth about what your agency does and why it matters, loudly enough and often enough that the families who need you can find you.
If your team is thinking through how to keep growing with confidence in this environment, that is exactly the kind of work we do at Transcend Strategy Group. We would welcome the conversation.
