Opioids, Star Ratings Among Top Regulatory Issues in Hospice

The hospice care space has become the hot acquisition target of the moment, in part because buyers see high margins and fewer regulatory hurdles when compared against home health care. However, that does not mean hospice is entirely spared from new and evolving hurdles and regulatory obligations.

From opioid-related legislation to forthcoming Hospice Compare changes and quality reporting mandates, agencies are on their toes to maintain compliance and competitiveness as requirements shift. Here are some of the upcoming and ongoing regulatory issues for the hospice industry:

Opioid legislation


Hospice providers and caregivers have a role to play in the U.S. opioid crisis. Current laws dictate that hospice providers don’t have responsibility over prescription drugs for patients once they pass away. Instead, that responsibility is left with families, meaning the drugs can end up in the wrong hands, creating a prime opportunity for abuse if they are not destroyed or disposed of properly.

Hospices have increasingly dealt with stolen medications as the opioid crisis around the country has steadily worsened; every day more than 115 people in the U.S. die after overdosing on opioids, according to data from the Centers for Disease Control and Prevention (CDC).

“There’s an unbelievable amount of pressure on Congress to do something about it,” Judi Lund Person, MPH, CHC, vice president of regulatory and compliance at the National Hospice and Palliative Care Organization (NHPCO), said at the association’s recent leadership conference. “That’s coming down to the Centers for Medicare & Medicaid Services (CMS).”


Some states have taken the issue into their own hands while the national debate rages on, with Kentucky introducing a bill in February to allow hospices to dispose of drugs.

A new federal bill, The Opioid Crisis Response Act of 2018, aims to tackle the issue by improving the disposal of medications and enabling hospices to “safely and properly dispose of controled substances for the deceased.” The legislation, which also contains numerous other proposals to combat the epidemic, was approved by the Senate Health Committee in April, but has not had a floor vote.

While the bill is a step in the right direction, it does not contain language for hospices to dispose of medications when care plans are switched and patients no longer need the same prescriptions, according to Person, who says the association is working with policymakers to potentially adjust the language and solve the issue.

Hospice star ratings and Hospice Compare

Over the past few years, hospices have seen the introduction of quality care reporting measures. Similar to Home Health Compare, CMS introduced the website Hospice Compare, which became live in August 2017, to display metrics related to quality of care and patient experience.

Hospice Compare displays seven Hospice Item Set (HIS) quality measures and recently added survey information from the Consumer Assessment of Healthcare Providers & Systems (CAHPS), which relates to consumer satisfaction and experience.

Soon, however, hospice providers will likely be ranked with star ratings, ranging from one to five stars that reflect quality levels based on the HIS and CAHPS metrics.

“They’re coming,” Person said.

In addition, CMS is also considering a number of other potential measures to be added to the data set, including live discharges, which have ticked up as of late. The comment period for the proposal ended April 25, 2018.

Additionally, CMS recently proposed making the Hospice Quality Reporting Program (HQRP), which encompasses Hospice Care, less burdensome in its most recent payment update for 2019. Specifically, CMS proposed no longer directly displaying the seven component measures on Hospice Compare, instead only displaying the composite measure.

HEART tool 

Hospice providers are also on the watch for the ongoing implementation of the Hospice Evaluation and Assessment Reporting Tool (HEART), which is an expanded item set that covers the comprehensive patient assessment and is being pilot through two sequential phases.

The project aims to develop a data item set that would paint a broader picture of the quality of care provided by hospices, according to CMS, and a more comprehensive understanding of patient needs and service delivery for hospice patients. It will include current measures from the HIS and additional clinical items. It will also complement the conditions of participation (CoP) requirements.

The first phase has already been completed, and the second piloting phase is due to start n June 2018, followed by an analysis in September. Eventually, the tool could be rolled out across the industry.

Written by Amy Baxter

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