In addition to providing excellent patient care, home-based care providers must be well-versed in matters of public policy, according to Dr. Steven Landers, CEO of the National Alliance for Care at Home. 

Changing regulations and workforce shortages have created a churning undercurrent of risk in both the home health and hospice industries, Landers said. In this environment, hospice and home-based care providers need a deep understanding of the wide scope of changes happening at the policy, legislative and regulatory levels, Landers recently told Home Health Care News.

This year has come with a new presidential administration as well as a change of guard in leadership for the U.S. Department of Health and Human Services (HHS), the U.S. Centers for Medicare & Medicaid Services (CMS) and in Congress. Hospice and home health providers need a firm grip of insight into the new priorities that are taking shape, and the potential impacts on care delivery and workforce sustainability, according to Landers. 

HHCN sat down with Landers to discuss the most pressing issues in the industry, including reimbursement hurdles, the Trump administration’s approach to Medicare and strategies to improve employee retention.

The interview has been edited for length and clarity.

HHCN: What are some of the “under the radar” trends taking shape in hospice and home-based care? What is important for providers to understand about these trends?

Landers: We live in a world where news travels pretty fast and there are things that aren’t entirely known. Probably one of the biggest areas of question marks for everyone is exactly how, from a public policy standpoint, our new administration with new HHS and CMS leadership and a new Congress will handle issues related to care at home.

Areas that are a bit unknown are the balance between really sound program oversight and burdensome regulation and processes that harm access. We know that Dr. [Mehmet] Oz who’s recently been confirmed as CMS administrator is poised to focus on waste, fraud and abuse early in his tenure. At the same time, we know that the Trump administration is very concerned about deregulation over regulation. How that needle gets threaded between both needing to address very real concerns around fraud and abuse, and then at the same time do it in a way that is business-friendly, provider-friendly and reasonable. That is something to really watch.

There’s [also] a lot of broad brushstroke conversation in the ether about different topics … There’s a lot of unknowns. Some of the things to pay attention that may not be on the tip of everyone’s tongue are what role will Medicare Advantage play in the future. Medicare Advantage is a massive strategic issue for the whole care at home community. Will we see continued growth, or even accelerated growth, because of the policies that are accommodating, or will we see some of the scrutiny and critiques that have been part of recent conversations around Medicare Advantage? Will we see those slow the pace or just sort of maintain the status quo there?

The broader topic of value-based models, whether it’s through MA growth or other reforms within Medicare and Medicaid, that story continues. For providers to be successful, they’re going to have to continue to evolve their care models and their technology.

Do you foresee any overlap or parallels of challenges among hospice and home health care providers in coming years?

For all of us who care for people with serious chronic illness and care for an aging population, we’re all concerned about who will provide the care. This is a dominant issue. The areas of highest concern are the nursing and personal care workforce.

Where will our providers get the purchasing power to make sure that home care and hospice have what it takes to compete in this war for talent? When we look at what’s happened with payment updates and inadequate inflationary adjustments, basically the purchasing power of home health, hospice, home care providers to compete in this talent war has eroded. It’s eroded in addition to needing to find ways to get a new workforce, creative policy and creative programming at the provider and local community levels. [It’s] finding ways to pull more people into caring fields, to build these earn-while-you-learn pathways for our workforce so that we’re moving people up, and also so people don’t see their jobs as dead ends but as real growth.

Of course, the topic of reimbursement is an issue that cuts across all these areas. What reimbursement means in our world is the ability to recruit and retain talent. By and large, it’s a question of what resources are there to bring people into care delivery and the leadership you need in this sector is critical.

The other area that cuts across all providers in this serious, chronic illness and aging care space is where does government oversight go? How is that oversight done in a way that truly gets rid of sham and criminal operations, which have no business in health care at all. At the same time, you have well-run and well-managed providers in the country wasting their resources on things that ultimately get adjudicated in their favor, but after much hassle, expense and distraction from actually taking care of people.

What’s on the Alliance’s home health legislative and regulatory wishlist for 2025?

The implementation of the Bipartisan Budget Act of 2018’s home health payment reform, or otherwise called the implementation of the new Patient Driven Groupings Model (PDGM) by CMS, has been a disaster. This was intended to be a budget-neutral modernization of the home health benefit, but it’s turned into a massive cut. There are delays in care, unfilled referrals and millions of less visits. Because it’s been a massive cut, billions of dollars have been sucked out of the system, even though that wasn’t what Congress intended to do.

So, our priority is that the Trump administration, Dr. Oz and their Medicare team stop the presses on the continued destructive implementation of this program. They’ve signaled that they plan to continue to implement these “behavioral adjustments,” which is another term for cutting Medicare home health. We know that the law gives HHS and CMS officials total discretion to hit the pause button and not move forward with those in 2026, so we want to see them stop this destructive implementation and work with home health stakeholders on a longer-term fix to this implementation. That’s a big deal.

What are some of the key home health issues the Alliance is rallying around this year?

When we talk about home health, another area that we don’t have a specific ask on, but is very much an area of focus for analysis and problem solving right now is access to home health for Medicare Advantage beneficiaries. There is growing concern with whether Medicare Advantage beneficiaries are getting comprehensive home health services that are prescribed under the Medicare benefit, or [whether] some of the administrative and financial barriers within Medicare Advantage have watered down what beneficiaries get. That’s an area we’re exploring, what policy options might improve that situation.

Beyond reimbursement, there’s issues around prior authorizations and utilization management, [claim] denials and clawbacks and other things. [It’s also] making sure that access is strong. Medicare Advantage is a popular program with beneficiaries. The lower cost-sharing and supplemental benefits have contributed to wild growth of these plans, and so now many more beneficiaries are in Medicare Advantage than say, five or 10 years ago. For Medicare Advantage to continue to grow and be strong, it needs to evolve with some of these issues around care at home. We want to see Medicare Advantage succeed in terms of its relationship with home health.

Another home health issue we want to make sure of is that when this continuing resolution expires, that telehealth flexibilities get extended. That will be on our radar, and advocating for that is an important topic as well.