Having an adaptable approach to compliance is key in an evolving hospice regulatory environment.
The regulatory climate has seen an array of changes aimed at curbing fraud in the industry and improving quality. Heightening oversight has focused on hospice program integrity efforts, as well as increased auditing activity, changes in rules for hospice sales and financial penalties tied to quality reporting measures.
Also starting this year is a Special Focus Program for hospice providers from the U.S. Centers for Medicare & Medicaid (CMS).
Preparing for ongoing regulatory scrutiny will involve having a nimble compliance approach, according to Andrew Molosky, CEO of Chapters Health.
“It’s not a static issue. It’s a living, dynamic and evolving thing,” Molosky said during the Hospice News 2024 Outlook Webinar. “If you have an organization that views compliance and regulatory adaptation as an underpinning of who they are, you’re going to have an easier time taking constant hits. The reality is more is going to come, the government will ‘use a cannon to kill a mosquito.’ There’s a different way. [It’s] not to be less regulatory, but to be more effective.”
Watch (click here): Hospice News 2024 Outlook Webinar
Though important moves to address fraud, waste and abuse issues in hospice, the increased regulatory oversight has come with operational burdens and financial costs to providers, Molosky stated. Hospices may be facing financial headwinds when it comes to investing in compliance efforts, but the return on investment is sustainability, he said.
Navigating changes in rules and regulations will be a large part of the hospice business model, according to Molosky.
“You build a regulatory team that is, yes, expensive and requires investment too, it needs the time and effort,” Molosky told Hospice News. “Even though it’s not sexy, flashy or has teeth, it does the day the storm shows up. That’s what an organization that navigates regulatory changes well, never falls behind, realizes its cost of doing business and views it as a dynamic part of their culture and not a burden they have to live with. It’s how to eat an elephant one bit at a time.”
The future compliance outlook will involve hospices having a vigilant review process to help identify potential risks, according to YoloCares CEO Craig Dresang. Crucial to compliance is a hospice’s ability to assess its care delivery approaches, billing and patient intake processes, as well as clinical documentation, Dresang said.
“We started identifying and naming the areas we thought we could be vulnerable in terms of compliance or some of the regulatory shifts related to quality,” Dresang said during the webinar. “We put pen to paper, we named those things, and then really had our education department focus on partnering with the clinical side of the house to drive that quality.”
One approach to ensuring compliance is tying incentives around quality, Dresang added. California-based YoloCares has rolled out a performance pay system that includes incentives/bonuses for clinicians who meet certain quality standards. This system has helped improve understanding of compliance importance, he said.
“In terms of meeting the needs of the regulatory environment and compliance, we have a performance pay system that rewards clinicians on every paycheck for meeting certain standards that we’ve set up or created,” Dresang said. “That keeps us in a safe zone for compliance and quality, and it has moved the needle. I think we have to look at creative ways to drive this in our organizations.”
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