NHPCO Launches Education Program to Improve Hospice Quality

The National Hospice & Palliative Organization (NHPCO) has launched a new large-scale initiative designed to help providers systematically assess and improve the quality of care they provide. The Quality Connections program will use didactic instruction and evidence-based tools to drive performance improvement.

Focusing on quality can yield significant results for a hospice’s bottom line. With the U.S. Centers for Medicare & Medicaid Services (CMS) publicly reporting hospice quality data, consumers, referral partners and payers are increasingly using that information when selecting a hospice to work with or engage to care for a loved one.

“There is a baseline [to Quality Connections that is very much tied to what falls into the compliance bucket, and then there’s excellence in the metrics that a provider has to put together in order to demonstrate the effectiveness of the care that they provide,” NHPCO President & CEO Edo Banach told Hospice News. “This is completely related to the provision of value-based care contracting with managed care plans, direct contracting and so forth. You are actually able to demonstrate to a payer that you are adding value.” 


Demonstrating the value proposition of hospice care will be key to negotiating with payers as providers move towards a value-based payment landscape. CMS’ value-based insurance design demonstration, often called the Medicare Advantage hospice carve-in, took effect Jan 1. In April the agency is expected to launch its value-based Serious Illness Population and direct contracting payment models.

The scope of Quality Connections will extend beyond the quality measures hospices are required to report to the U.S. Centers for Medicare & Medicaid Services (CMS) and will instead focus on development of organization-wide best practices.

Throughout the 12-month program, participating providers will complete certain benchmarks within a designated timeframe for each of four programmatic pillars to achieve and sustain continuous quality improvement: Education, Application, Measurement and Innovation. The participating hospices will be encouraged to share the best practices they develop with their peers in the field to drive up quality industry-wide.


“The individuals that participate on behalf of their [hospice] program will be going through a fairly rigorous process of learning and dissemination of best practices, which is going to put them in a position to really be at the front of the line of excellence,” Banach said. “Providers are actually going to actually have a leg up in terms of the tools that are available to them for improving quality.”

The move comes at a time when hospices are coming under tighter and tighter scrutiny from regulatory agencies in matters of quality, billing and accurate documentation.

The Office of Inspector General (OIG) at the U.S. Department of Health and Human Services in late 2018 issued a report on payment-related vulnerabilities in the Medicare hospice program. Based on its findings, OIG recommended that the CMS strengthen the survey process and improve oversight to “identify hospices that engage in practices that raise concerns.” This was the first in a series of OIG reports throughout 2018 and 2019 that identified payment and quality-related problems in U.S. hospices.

With more hospice reports in the works at OIG, providers can likely expect that regulators will continue to keep a close eye on the space, which could have a significant impact on organizations’ patients as well as their financial health. Other federal stakeholders, such as the Medicare Payment Advisory Commission have also raised quality concerns regarding hospice care.

The program is available at no additional cost to NHPCO’s approximately 1,100 organizational members, which represent about 4,000 hospice locations. 

“This is not the bare minimum Conditions of Participation that you’re required to do in order to be a provider,” Banach explained. “The time is way past for providers to strive for excellence, both to differentiate themselves from their competition and because it’s what patients and families deserve.”

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