The barometer is falling in hospice care delivery. Providers are unveiling diverse tactics to improve outcomes and family satisfaction amid a sea of changes.

Adaptability is a provider’s hallmark in today’s current hospice landscape, according to Greg Wood, executive director at Hospice of the Ozarks.

The Arkansas-based nonprofit is affiliated with Baxter Health and provides hospice and palliative care in a predominantly rural region of the Ozark Mountains. Hospice of the Ozarks also has a veterans program and offers pet therapy services.

“It’s finding a way to drill down on the details of real-life, daily experiences and figure out how to change our processes to get a good end result,” Wood told Hospice News. “When we show attention to the human experience, follow their self-determination, desires and hopes, then we have a much better chance to provide and perceive quality. We’ve developed performance improvement projects that change our processes, because these help us reconcile and build better best practices.”

Multiple support avenues

Having internal checks and balances is significantly important to ensuring quality, Wood said. Everything from patient admission to medication management and more is on the table of thorough examination, he added. Internal reviews can help to proactively identify issues stymieing progress on improved outcomes.

Case in point, a performance improvement project implemented at Hospice of the Ozarks helped the organization to instill better practices for medication reconciliation during patient admission and referral processes, Wood stated. As a result, the hospice saw smoother solidification of patients’ plans of care.

Hospices’ varied pathways to improved quality have included diversification of services, leveraging technology for more timely access and boosted operational efficiency, honing organizational culture and strengthening referral relationships and community partnerships, among other tactics.

A key sticking point for quality is being responsive to urgent care needs, according to Samira Beckwith, executive vice president of public policy at Chapters Health System. Timely access to support is essential to good outcomes, she said.

The hospice provider has a triage 24/7 call line for patients and caregivers to connect with clinical and social worker teams. Having a “round-the-clock” care approach comes with staffing and operational considerations, but also improved symptom management and caregiver satisfaction, Beckwith said.

“Our team is there to respond around the clock, we have that intermittent care that is very important to keeping people comfortable and adding quality,” Beckwith told Hospice News. “It’s the ‘sundown effect,’ where the worst things seem to happen and look the darkest before dawn. People need answers, and having somebody available on the phone provides that caregiver support.”

The nonprofit Chapters Health System affiliated in 2022 with Florida-based Hospice and Community Services Inc., DBA Hope HealthCare Services. The hospice offers adult and pediatric care care, bereavement, veterans services and Programs of ALL-Inclusive Care for the Elderly (PACE), among other services.

Beckwith is also co-founder of the National Partnership for Healthcare and Hospice Innovation (NPHI) and also founder and president of the Florida PACE Provider Association.

Goals-of-care conversations are an important opportunity to set the bar for positive hospice experiences, according to Beckwith

Patients and families need to understand both the range of interdisciplinary services included in the Medicare Hospice Benefit in order to set reasonable expectations for their care, she stated. This means open and effective communication is key to quality and satisfaction.

“It’s explaining what’s happening in language that people can understand and hear during a very difficult time,” Beckwith said. “Communication is so critically important so that we can better meet their expectations. It’s having staff be comfortable having these conversations and listening to what is important to the patient and family members and be really tuned into what drives quality, because we don’t have a chance to do this again differently.”

Regulatory complexities

Two main regulatory factors are impacting hospice quality in 2025. These include increased auditing activity and the implementation of a new quality reporting system taking effect in October, the Hospice Outcomes and Patient Evaluation (HOPE) tool, which replaces the Hospice Item Set (HIS).

Acclimating to a different set of quality measurements with the HOPE tool has some providers furrowing their brows over logistics, according to Wood.

Technology will play an important role in the ability to navigate a new quality reporting system, he said. But updating technical capabilities can come with large costs as some hospices retool their electronic medical record software systems in preparation of the HOPE tool.

“There’s some anxiety with the HOPE tool about submitting the information correctly,” Wood said. “There are multiple screens of data, and it’s easy to get hung up in the process. It seems more cumbersome in a sense that there’s more detail. That’s probably one of the biggest struggles I’ve heard so far. We just have to learn the process more.”

These regulatory changes come at a time of rising program integrity concerns. Fraudulent operators have increasingly stepped into the hospice space, particularly in four hotbed states of Arizona, California, Nevada and Texas.

The regulatory climate has complicated hospices’ ability to communicate the value and quality of their services and simultaneously break down common barriers of public misconceptions.

“How we’re doing in hospice and a lot of health care is over-regulated, and yet many of the regulations don’t focus on quality. We have to look at how to best utilize our resources as well as possible,” Beckwith said. “You have to be as efficient and effective as possible without sacrificing quality to maintain that level of care and still keep your identity. Quality is number one, that’s the reputation.”