The soon-to-be-implemented hospice Special Focus Program (SFP) from the U.S. Centers for Medicare & Medicaid Services (CMS) may produce misinformation that could interfere with access to care.

The program, set to begin Jan. 1, 2025, could potentially lead patients away from quality providers and into the arms of bad actors in the space, according to Dr. Steven Landers, newly appointed CEO of the National Alliance for Care at Home. The Alliance was formed by the merger this year of the National Hospice and Palliative Care Organization and the National Association for Home Health & Hospice.

“We think that [the CMS] methodology [for the SFP] is likely flawed. It is likely to harm beneficiaries if it’s released, because it’s going to steer people away potentially from quality providers,” Landers said in a press briefing on Thursday. “It might make them even fearful about hospice care, which is the last thing we want to see happen. At the same time, [CMS’] implementation misses likely lots of truly poor performing hospices that should be called out and addressed.”

Congress mandated the SFP in the Consolidated Appropriations Act of 2021, which contained language from the Helping Our Senior Population in Comfort Environments (HOSPICE) Act. This was in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS).

The program will have the authority to impose enforcement remedies against hospices with poor performance based on its algorithm. Hospices flagged by the SFP also will be surveyed every six months rather than the current three-year cycle and could face monetary penalties or expulsion from the Medicare program.

CMS will also make public the names of hospices selected for the SFP, putting a “Scarlet Letter” on providers who may be in the program as a result of flawed data, according to Landers.

“We are asking CMS to not release the list that they’ve been developing, because as part of the special focus program they’re instructed to develop a list of the 10% poorest quality hospices,” Landers said.

The key point of contention around the SFP is the algorithm that CMS plans to use to determine which hospices should be in the program. Though the hospice community generally has voiced support for the program, many have said that the agency’s methodology for identifying hospices for the SFP is deeply flawed. Stakeholders, including hospice providers and members of Congress, have called on CMS to postpone the program and revise that algorithm.

“It’s not being implemented consistent with how Congress envisioned it,” Landers said. “The very people that were involved with the legislation to start the Special Focus Program in the first place are with us, locked arm in arm to try to fix this. It’s not what they envisioned when this law was written.”

Some lawmakers have taken action to reform the aspects of the SFP, though the outcome remains to be seen. Reps. Beth Van Duyne (R-Texas) and Jimmy Panetta (D-California) have introduced the Enhancing Hospice Oversight and Transparency Act, which is designed to improve the SFP selection process as well as transparency around the program.

The legislation, if enacted, would require the agency to make public the data used to determine a provider’s eligibility for the SFP, as well as the algorithm used to make that determination.

The bill would also forbid CMS from placing a hospice into the SFP unless it had undergone a state, local or accreditation agency survey during the most recent 36-month period. Nearly 40% of hospice providers have not undergone a survey within the past three years, CMS has reported. This is critical as survey results are a key factor in the agency’s SFP algorithm.

“The law that set up the hospice Special Focus Program was all about surveys …” Landers said. “The program was intended to make sure people knew about truly poor quality hospices, and many of those are going to fly under the radar because the surveys aren’t done and because the model to develop this program is flawed. So this is harmful to people and it’s going to hurt access.”