Our Response to ProPublica Article Alleging Abuse in Medicare Hospice Benefit

An article on the hospice industry published by ProPublica on November 28 (Endgame: How the Visionary Hospice Movement Became a For-Profit Hustle), 2022, gives readers an inaccurate view of the Medicare hospice benefit, a uniquely person-centered program that brought comfort to 1.7 million Americans and their families in 2020.

The article utilizes a few instances of abuse by bad actors to assert that hospice has lost its way. While we condemn fraudulent or abusive behavior, the vast majority of hospice providers remain true to its historic mission of providing comfort and relief from suffering to individuals at the end of life and support to their loved ones.  This is evidenced by Centers for Medicare & Medicaid Services (CMS) data indicating that 81 percent of families/caregivers utilizing the Medicare benefit give the hospice an overall rating of 9 or 10 (with 10 being the best) and 84 percent would recommend hospice to family and friends.

Where inappropriate activity is occurring in hospice, the National Association for Home Care & Hospice (NAHC), hospices across the country, and other industry stakeholders have urged meaningful action, including our support for increasing the frequency with which hospice providers are reviewed for compliance with important health and safety standards (Medicare’s Hospice Conditions of Participation).  Further, in 2019, NAHC other national hospice organizations helped craft a series of hospice survey reforms that were enacted in the Hospice Act of 2020, which are currently being put in place. We expect these reforms, once fully implemented, to provide additional quality of care safeguards in the hospice benefit.

More recently, NAHC and other national organizations have been deeply concerned about the disproportionate growth in the number of hospices in some states. In November 2022, NAHC and three other national hospice organizations wrote to CMS Administrator Chiquita Brooks-LaSure, urging further investigation of the proliferation of hospices in some states and to suggest targeted moratoria in trouble areas of the United States.

“We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones,” said NAHC President William A. Dombi. “Unfortunately, articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys.”

The hospice benefit is popular, well-regarded, and saves taxpayer dollars compared to keeping terminally ill patients in hospitals or other institutional centers of care. NAHC and our members look forward to working with federal and state policymakers to implement solutions to address the isolated problems highlighted by the article without jeopardizing access to the Medicare hospice benefit.