Home Health & Hospice Week

But what exactly should constitute a conflict?

If the latest proposed rule regarding hospice survey changes is finalized as-is, hospices will be able to worry less about surveyors with an agenda.

Among the changes the Centers for Medicare & Medicaid Services proposes in the home health 2022 proposed rule published in the July 7 Federal Register is a new list of conflicts of interest that would prohibit a surveyor from surveying a hospice.

The conflicts include “that a surveyor would be prohibited from surveying a hospice program if the surveyor currently serves, or within the previous 2 years has served, on the staff of or as a consultant to the hospice program undergoing the survey” and having a financial interest in the hospice, according to the rule. The same would go for an immediate family member’s financial interest, CMS proposes.

“It is essential to prohibit conflicts of interest to maintain the integrity of the accreditation process,” says The Joint Commission’s Margaret VanAmringe in the AO’s comment letter. The Joint Commission “has a robust policy in place to prevent real or perceived conflicts of interest. This policy includes surveyor affiliation with an organization via personal business relationships or immediate family members,” she adds.

“UnityPoint at Home … supports this requirement,” says the Des Moines, Iowa-based health system in its comment letter.

Add These Conflicts To The List

Many other commenters agree. But hospices and their reps have a few more items they’d like to add to the conflict-of-interest list.

“CMS should consider a 2-year ban on staff from competitor hospices (based on geography) surveying one another,” suggests LeadingAge’s Mollie Gurian in the trade group’s comment letter. Multiple commenters echo this suggestion.

The same should go for surveyors with financial interests in a competitor, UnityPoint proposes.

And what about “circumstances under which a surveyor may have applied for a position at a hospice it may now be surveying,” the National Coalition for Hospice and Palliative Care asks in its comment letter.

That prohibition could probably just cover “key management positions” and “similar positions at other hospice providers in the same service area,” offers the National Partnership for Healthcare and Hospice Innovation in its comment letter.

Catch: “It may be challenging to address this issue as it would be necessary to define competitor and, in the case of a hospice with multiple locations, how far the prohibition would extend,” acknowledges Lauren Reynolds with At Home Nursing Care Inc. in Encinitas, California, in her comment letter.

Another one: “Consider prohibiting surveyors from surveying a hospice who ever had a family experience with that hospice — whether good or bad,” Gurian suggests.

“CMS should develop a surveyor Code of Ethics or Attestation relative to conflicts of interest to convey that surveyors are responsible for maintaining objectivity throughout the survey process,” the Coalition tells CMS. That would cover conflicts not specifically enumerated. “An attestation or agreement to a Code of Ethics should be addressed in the CMS Surveyor Hospice Training Modules and could be signed by the surveyor during the training process,” the Coalition says.

“While the surveyor exclusion criteria CMS proposes is a good start towards meeting the goal of avoiding potential conflicts of interest, we believe additional processes are necessary to protect hospices more fully from surveyor bias,” says the National Hospice and Palliative Care Organization’s Edo Banach in the trade group’s comment letter. That would include “a more global solution … where there is a process in place for a surveyor to declare a conflict of interest, there is guidance for SAs and AOs on addressing conflicts of interest, and training on conflict of interest is added to the CMS Surveyor Training Modules,” he says.