The hospice industry faces significant regulatory challenges that have become more pronounced in recent years, with key concerns including evolving telehealth policies and program integrity issues. These challenges were highlighted by hospice professionals in the 2025 Outlook Survey conducted by Hospice News and Homecare Homebase. As the industry adapts to a changing regulatory landscape, providers must navigate complex issues to ensure they can continue to deliver high-quality care while maintaining financial sustainability.
Evolving Telehealth Policies
Impact on Patient Access
The advent of the pandemic saw temporary waivers that allowed the expanded use of telehealth, significantly benefiting hospice providers by enabling them to reach patients in rural and remote areas. These waivers permitted practices such as virtual face-to-face recertifications and additional supportive services, which proved crucial in times of staffing shortages. However, as the expiration dates of these waivers draw near, there is growing anxiety among providers and stakeholders about the potential negative impact on patient access if telehealth options are reduced. The loss of these flexibilities could hinder the ability to provide timely and effective care to patients who live far from healthcare facilities.
This potential reduction in telehealth services has raised considerable concerns about how hospices will continue to serve their patients without compromising the quality of care. The effectiveness of telehealth during the pandemic demonstrated its value not only in providing medical consultations but also in offering emotional and psychological support, which is vital in hospice care. The industry is now faced with the challenge of advocating for the extension or permanent implementation of these telehealth services to ensure that patient access is not adversely affected, especially in underserved areas.
Dual Nature of Telehealth
Telehealth presents a dual-edged sword for the hospice industry. On one hand, it has significantly improved access to care for patients who might otherwise struggle to receive timely services. On the other hand, an over-reliance on telehealth could potentially hinder the personal, face-to-face interactions that are an integral part of hospice care. This dichotomy has made the telehealth debate particularly contentious among hospice providers, who are keenly aware of the need to balance technological advancements with the irreplaceable value of in-person care.
Hospice providers are closely monitoring regulatory developments to determine how telehealth will be incorporated into the broader care delivery model. The goal is to strike an optimal balance that leverages the benefits of telehealth without compromising the hands-on care that is essential for the well-being of patients. This balancing act requires ongoing dialogue with regulators, continuous assessment of patient outcomes, and the flexibility to adapt as new regulations are implemented. The dual nature of telehealth makes it a critical area of focus for the hospice industry, as providers seek to integrate it in ways that enhance rather than detract from patient care.
Program Integrity Concerns
Fraudulent Activities in Hospice
The hospice industry continues to grapple with significant concerns regarding program integrity, particularly in the realm of Medicare fraud. Fraudulent activities within the industry, such as enrolling ineligible patients and engaging in “license flipping,” where operators quickly sell their licenses to evade regulatory scrutiny, remain persistent issues. These fraudulent practices not only misappropriate Medicare funds but also undermine the trust and integrity of the entire hospice system. As these activities continue, there is mounting concern about the future payment structures, access to care, and overall sustainability of the industry.
These fraudulent behaviors have made it increasingly challenging to distinguish between legitimate hospices and those that are exploiting the system for profit. The complexity of these schemes often complicates efforts to implement effective oversight and enforcement measures. As a result, quality hospice providers may find themselves subject to undue scrutiny and regulatory burdens intended to curb fraudulent activity. The hospice industry must work collaboratively with regulators to develop robust mechanisms that can accurately identify and address fraud while supporting the providers committed to delivering high-quality care.
Enhanced Auditing Pressures
The intensification of auditing activities has significantly increased operational pressures on hospice providers. More than half of hospice providers have reported experiencing multiple simultaneous audits, which has placed considerable strain on their resources and operational capabilities. These audits are not only time-consuming but also come with the added challenge of inconsistent interpretations by auditors, making it difficult for providers to ensure compliance confidently. This inconsistency in enforcement practices has resulted in a landscape where even providers who diligently adhere to regulations find themselves under intense scrutiny.
The mounting pressures from enhanced auditing activities necessitate that hospices allocate additional resources to manage audit responses effectively. For instance, providers may need to expand their compliance teams to handle the increased regulatory demands. These resources, however, could otherwise be directed towards improving patient care. The inconsistency in audit interpretations further exacerbates the situation, creating a sense of unpredictability for hospice providers. Addressing these issues requires a concerted effort to standardize audit practices and ensure that enforcement is applied consistently and fairly across the industry.
Special Focus Program (SFP)
Introduction and Suspension of SFP
The Special Focus Program (SFP) was introduced with the intent of identifying poorly performing hospices and mandating quality improvement measures. However, its flawed methodology quickly became a point of contention within the hospice industry. The program, part of the 2024 home health payment rule finalized by the Centers for Medicare & Medicaid Services (CMS), sought to bring new scrutiny and potential penalties to underperforming providers. Yet, the introduction of the SFP led to immediate criticism due to the inclusion of many hospices that had previously maintained good quality scores.
The program’s shortcomings prompted legal action, with providers and state associations filing a lawsuit against the U.S. Department of Health and Human Services (HHS), seeking to halt the program’s implementation. In response, the Trump Administration decided to suspend the SFP pending further review. The suspension brought temporary relief to hospice providers who had been flagged by the program, but it also highlighted the need for a more accurate and fair methodology for identifying and addressing issues within the industry. The suspension of the SFP underscores the complexity of developing effective regulatory measures that genuinely enhance care quality without penalizing high-performing providers unjustly.
Industry Skepticism and Calls for Redesign
The initial implementation of the SFP exposed significant issues with its selection criteria, resulting in widespread skepticism within the hospice industry. High-quality hospices were included in the program’s initial cohort, highlighting the flawed design and raising serious concerns about the program’s efficacy. Industry leaders have been vocal in their calls for a reset of the SFP, advocating for a more robust and equitable approach to identifying and addressing operational and quality issues. The goal is to ensure that only truly underperforming hospices are targeted, thereby protecting high-quality providers from unnecessary penalties and scrutiny.
The redesign of the SFP is not just a matter of improving selection criteria; it also involves addressing broader concerns about how quality is measured and enforced within the hospice industry. Providers are urging CMS to take a more collaborative approach, working with industry stakeholders to develop a program that accurately reflects the complexities and challenges of hospice care. This includes ensuring that any new measures or penalties are equitable, transparent, and focused on genuinely improving patient outcomes. The industry remains committed to driving quality improvements while protecting providers from undue regulatory burdens.
Legislative and Compliance Efforts
Push for Permanent Telehealth Implementation
The legislative landscape is increasingly focused on the push for permanent telehealth implementation, recognizing its potential to modernize hospice care and remove regulatory uncertainty. Legislators are advocating for the continuation of telehealth options that were temporarily put in place during the pandemic, with the aim of making these measures permanent. This legislative effort is driven by the recognition that telehealth has significantly improved access to care, particularly for patients in remote and underserved areas. By making these options permanent, the industry hopes to enhance patient care and ensure that hospices can continue to leverage technology effectively.
The push for permanent telehealth implementation also encompasses a reevaluation of eligibility timeframes, allowing agencies to better understand patient needs and develop appropriate care plans. Legislative efforts in this area are crucial for providing hospices with the stability and clarity needed to plan for the future and invest in telehealth infrastructure. By solidifying these measures into law, the hospice industry can continue to innovate and improve care delivery, ultimately benefiting patients and their families. The focus on legislative support for telehealth is a testament to its importance in the evolving landscape of healthcare.
Staffing and Public Awareness Challenges
The hospice industry is currently facing significant regulatory challenges that have intensified in recent years. Key concerns within the field include changing telehealth policies and issues surrounding program integrity. These challenges were prominently highlighted by hospice professionals who participated in the 2025 Outlook Survey, which was conducted by Hospice News in collaboration with Homecare Homebase. As the regulatory landscape continues to evolve, hospice providers must skillfully navigate these complex issues. This will ensure they can maintain their commitment to delivering high-quality care while also ensuring their financial stability and sustainability. The ability to adapt to these regulations is essential for the industry to thrive and continue providing crucial end-of-life care to patients in need. The survey underscores the urgency of addressing these regulatory hurdles to support the ongoing mission of hospice care services.
