Home Health & Hospice Week

Bad news: The oversight program for poor performing hospices is still proceeding with plenty of flaws.

Hospices will have a bit of breathing room after all, before they tackle the Special Focus Program. In a Nov. 14 hospice forum, Centers for Medicare & Medicaid Services officials revealed that CMS would not make its first SFP selections until the fourth quarter of 2024.

That announcement comes despite the agency’s protests that “the SFP is the final [Consolidated Appropriations Act, 2021] provision to be implemented, and we believe further delay would likely impact patient and family health and safety,” according to the 2024 home health final payment rule released earlier this month.

“Based on comments in the rule, it was expected that CMS would run the algorithm for the SFP in the first quarter of 2024 and surveys of the chosen hospices would begin shortly thereafter,” notes Katie Wehri with the National Association for Home Care & Hospice.

For instance: “We would use data from November 2023 to identify the pool of hospices eligible to be in the SFP on or after January 1, 2024,” CMS offers in the rule published in the Nov. 13 Federal Register.

And “we proposed that the number of hospices selected to participate in the SFP would be determined in the first quarter of each calendar year,” CMS says elsewhere in the rule. “The claims-based quality measure data used in the algorithm is not available until November of each calendar year. This data is needed to run the algorithm, which is used to establish the aggregate score from which SFP participants are selected.”

But in the forum, a CMS staffer confirmed in the presentation and question-and-answer portions of the Zoom session that the first SFP selection will take place in the fourth quarter of next year.

Presumably, SFP surveys would begin in January 2025, observers expect.

That announcement left the National Hospice and Palliative Care Organization surprised, NHPCO’s Patrick Harrison tells AAPC.

While the program’s implementation date is still ostensibly January 2024, the selection won’t take place until the end of the year, the CMS official clarified.

That explanation gives the agency some cover for sliding the start date without officially changing it again, observers note. CMS bumped the SFP from 2023 to 2024 in the 2023 final rule.

The question remains, however, whether hospices will be able to make full use of their extra time. Multiple commenters on the proposed rule asked for preview data in addition to a delay (see HHHW by AAPC, Vol. XXXII, No. 32).

While “the data CMS is using to identify the lowest performing hospices encompasses hospice performance in a time period that has already passed … it would be helpful for CMS to share with hospices where they fall in the algorithm scoring so that they can identify and begin to work on improvement,” Wehri maintains.

The newly announced delay allows “additional time for the hospice community to prepare,” Harrison acknowledges. “But without additional data, it will be difficult for hospices to compare themselves to their peers and determine whether they might be selected for the Special Focus Program or fall in the bottom 10 percent of hospices under CMS’ final methodology.”

After all, a CMS source noted in the forum that hospices won’t be able to reproduce its SFP algorithm results, since it uses certain survey data that is not public.

“The SFP algorithm methodology will assist with approximating scores but will not be fully replicable due to variations in timeframes of data updates or acquisition,” CMS explains in the final rule.

Meanwhile, CMS also got a bit more detailed in the forum about how many hospices will land on the final SFP list.

As outlined in the final rule, hospices will be selected for the program based on their SFP algorithm scores. To start, CMS will identify the bottom 10 percent — those with the highest scores — and publicly display their inclusion on the 10 percent list on a CMS website (see related story, p. 324).

Then, going in “sequential order” by scores, CMS will choose the lowest-performing 1 percent of hospices to start the SFP, the CMS speaker explained. Again, the worst performers will have the highest scores using the algorithm.

That adds up to about 70 hospices undergoing the extra survey scrutiny, Wehri tells AAPC.