Regulatory, Financial Hurdles to Engaging Hospice Patients Upstream

Moving hospice further upstream can have beneficial impacts for patients experiencing a range of acute, serious, chronic or terminal illnesses. But reaching patients sooner in their illness trajectories can also come with financial and regulatory risks.

One of the largest barriers to building out a broader continuum of services are the regulatory and financial risks involved, according to Susan Ponder-Stansel, president and CEO of Alivia Care.

Ramped up oversight in hospice and shifting regulations in assisted living and skilled nursing can pose “some real difficulties” for providers navigating service diversification upstream of end-of-life care, Ponder-Stansel said at Aging Media Network’s CONTINUUM conference in Washington, D.C. Rising labor costs have additionally challenged service expansion as hospices balance workforce needs against reimbursement strains, she noted.


“It’s the risk involved, the capital that you need and the tolerance for failing a bit,” Ponder-Stansel told Hospice News’ sister publication Home Health Care News. “But also, I see regulatory barriers. ​​We’re a bit on the razor’s edge there in trying to figure out how to balance rising costs and keep the price where we can serve the community.”

Susan Ponder-Stansel Merz Photography / Hospice News
Susan Ponder-Stansel, president and CEO, Alivia Care Inc. at the CONTINUUM conference. Photo by Merz Photography.

The regulatory climate in hospice has heated up in recent years amid growing concerns of fraud, waste and abuse in the industry. Regulators have taken stronger oversight measures tied to program integrity through ramped up auditing activity and increased penalties for failure to comply with quality reporting measures, among other moves.

Another challenge for hospice service diversification is having the staffing capacity to keep up with upstream growth, according to John Kunysz, president and CEO of Intrepid USA.


Having the staffing infrastructure to build out additional service lines is essential for sustainability, but the ability to recruit and retain clinical capacity is a large hurdle for many hospices embattling financial pressures, Kunysz stated.

“There are companies out there [saying], ‘It’d be great for us because we can’t hire that infrastructure and build that out,’” Kunysz said during the conference. “The biggest challenge is breaking down the mentality [and deciding] who to partner with. Even the hospice folks, getting them to cooperate with our home health folks. You can’t build it all, because that access to capital is tough.”

John Kunysz Merz Photography / Hospice News
John Kunysz, President and CEO of Intrepid USA, at the CONTINUUM conference. Photo by Merz Photography.

The concept of service diversification in hospice has been evolving in recent years, according to SALMON Health CEO Matt Salmon.

While financial and labor pressures can hinder delving into services outside the scope of hospice, so too can fragmentation of the nation’s health care system, Salmon stated.

“It’s water grinding away at a stone rather than trying to figure out where I’m gonna get the capital or the staff for a significant expansion,” Salmon said. “The same health care issues that we talked about in 1990 we’re talking about today with the segmentation, the silos, the inefficiencies.”

Matt Salmon Merz Photography / Hospice News
Matt Salmon, CEO of SALMON Health, at the CONTINUUM conference. Photo by Merz Photography.

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