Jim’s Notebook: Risks That Come With Growth; Hospice CARE Act
I’m coming to you live from the Hospice News ELEVATE Conference in Charlotte! If you’re going to be there, please be sure to say hello, and thank you for being a part of the ELEVATE community.
ICYMI: Recent Inside Hospice posts
The Risks That Come With Growth
Today I read a fascinating piece posted on LinkedIn by Tonia Barrier, a registered nurse and chief clinical officer of Cadre Hospice.
The article, “Scaling Hospice Growth Without Increasing Compliance Risk,” looks at the risks that can arise in tandem with expansion and success.
Barrier highlights the changes that the hospice market has undergone over the past five years, including heightened demand, census expansion, regulatory scrutiny, workforce shortages and financial pressures.
“Sustainable growth in hospice is not simply a function of referral volume. It requires deliberate alignment between admission pacing, documentation infrastructure, workforce capacity, and quality oversight,” Barrier wrote. “Organizations that expand census faster than their operational systems can absorb often experience early signs of risk: delayed clinical documentation, variability in length-of-stay patterns, productivity instability, and heightened vulnerability in audits or survey activity.”
Barrier proposes a framework for more responsible, risk-avoidant business growth rooted in regulatory compliance and operational readiness.
I thought the piece included some remarkable insights that would prove useful for hospice leaders.
“In today’s environment, the most successful hospice organizations will be those that recognize safe growth as a leadership discipline grounded in foresight, structure, and measurable accountability,” Barrier wrote.
In my conversations with hospice executives over the years, I’ve seen that some organizations do adopt a similar approach. A frequent theme is they don’t want to “grow just to grow,” but want to expand in a way that most benefits patients, ensures compliance and fosters greater access to care. I salute leaders who prioritize being a better hospice, rather than the biggest.
The Return of the Hospice CARE Act
In the news this week, a congressional representative and a senator both re-introduced companion versions of the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, designed to modernize the Medicare Hospice Benefit, fight fraud and expand access to care.
The bill features a mix of program integrity provisions and payment reforms intended to “strengthen” the benefit, according to the lawmakers. It would bake in new anti-fraud guardrails and enhance government oversight of hospices. The legislation also proposes re-structured reimbursement methodologies designed to incentivize high-quality care.
A previous version of the bil was first introduced by former Rep. Earl Blumenaur (D-Ore.). We were deeply honored that Blumenaur chose to announce the legislation as Hospice News’ ELEVATE conference in 2024.
I first met Blumenaur during a visit to Capitol Hill, also in 2024. He was considerate enough to step out of a committee meeting to speak with me for about 10 minutes, and I was able to invite him to speak at ELEVATE.
Some aspects of the bill, I believe, are essential. One key example would be the development of a new payment model to support high-acuity palliative services like chemotherapy, blood transfusions, radiation and dialysis. Too many patients are denied access to these types of palliation, which could foster greater quality of life in their final days.
Moreover, many patients decide to forgo hospice care altogether because they fear they will lose access to those services. This is a serious problem.
I think payment reforms would serve hospices well. The Medicare Hospice Benefit has changed little since its 1982 inception and could use an update. However, some stakeholders have said that the specific proposed changes to payments for traditional services like Routine Home Care could cause adverse disruptions.
As this bill courses through Congress, I think it will prompt — and indeed require — a robust series of conversations about what the future of hospice care will look like. Personally, I do hope some version of this bill, even a revised one, will pass.
Hospice Fraudsters Strike Again
Hospice fraud is real, despicable and rampant. Recent developments include the discovery of 197 hospices that were operating out of the same location in Los Angeles County, California.
Other evidence arose that seriously ill seniors were being abused and starved at a care home operated by a fraudulent hospice. Nearby residents alerted authorities after hearing their cries for help. This is as disgusting as it is heartbreaking.
Check out Holly Vossel’s great reporting on these events and the ways regulators are fighting back.