Home Health & Hospice Week

It’s time to put your money where your surveys are.

New hospice survey procedures ranging from civil money penalties to surveys every six months for poor performers to public reporting of survey outcomes are poised for implementation. Hospices that aren’t ready may be forced to close their doors.

Many of the survey changes are required by the Consolidated Appropriations Act enacted last December. Hospice industry experts thought the implementing regulations for those changes might appear in the hospice rule this year, which was finalized in late July, but they did not. Instead, they showed up in the Centers for Medicare & Medicaid Services’ home health rule published in the July 7 Federal Register.

“For hospices, the consequences of withholding Medi-care payment is exceptionally burdensome due to the fact that the majority of all hospice patients are serviced under the Medicare Hospice Benefit,” points out Kim Skehan with SimiTree Healthcare Consulting (formerly Simione).

Hospices hoping for a reprieve from the new requirements in the home health final rule should resign themselves to their fate, experts maintain. While “some details of the survey process may change or be clarified some through [the regulatory commenting] process, hospice providers should assume that most of the rules will go through as substantively proposed,” believes attorney Liz LaFoe with law firm Husch Blackwell. “Many of the changes in the proposed rules are required by statute and must take effect in either 2021 or 2022,” LaFoe tells AAPC.

With many of the harsh mandates hitting nearly immediately, wise hospices should prepare now for them to take effect. Consider this advice from the experts:

1. Shift your priorities. Previously, the stakes for a survey were fairly low. “Historically for hospices, less-than-perfect survey performance may have resulted in minimal impact to operations — except in extreme cases,” LaFoe notes. “The addition of … new enforcement remedies will likely cause the impact of non-compliance to be felt at all levels of an organization,” she warns.

That means hospices may have to allocate a lot more resources toward survey compliance efforts. “Now would be a good time for hospice providers to dedicate the resources (time, money, and experienced staff) to improvement,” LaFoe advises.

2. Know your stuff. To achieve compliance with the hospice Conditions of Participation, you need to make sure your agency staff know them inside and out. “Hospices can best prepare by being certain they understand the Conditions of Participation fully and are implementing them as required,” says Katie Wehri with the National Association for Home Care & Hospice.

Furnish “staff and management education regarding the Hospice CoPs and other regulatory requirements,” Skehan recommends.

3. Don’t stop at education. You can’t ensure compliance with just training. “Coaching through home visits, clinical and personnel record reviews, interviews, and document review (such as QAPI, policies, etc.) are key,” Skehan stresses.

Make sure your agency isn’t missing its blind spots. “Mock surveys completed by objective parties” can turn up trouble areas, Wehri offers.

4. Target hot topics. Under the new regulations, surveyors are going to be gunning for certain high-profile and high-priority problems, including those related to quality of care and COVID, experts predict.

Expect “a focus on those Conditions of Participation CMS considers to be most closely related to patient care — 418.52 Patient Rights; 418.54 — Initial and Comprehensive Assessment of the Patient; 418.56 — IDG, Care Planning and Coordination of Care; and 418.58 — QAPI,” Wehri counsels.