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Where Hospices Should Focus in 2022

As we find ourselves entering 2022 with the pandemic still affecting hospice organizations, pulled in many directions with regulatory changes and staffing scarcities, operational success and seeing progress can be difficult.

This blog will get you back to surer footing and serve as a tool to equip you with what you need to be successful in 2022.

Hospice Checklist for Success in 2022


  • Beginning August 2022, a Family Caregiver Survey Rating Summary star will be posted on Care Compare as each hospice organization’s overall Hospice Consumer Assessment of Healthcare Providers Systems (CAHPS) rating. Using your QAPI program to drive quality is the key to success.
    • February 2022 is the reporting preview period for surveys from July 2020 – March 2021
    • May 2022 will resume regular four quarters
    • The first live posted star rating will be August 2022, comparing surveys from April 2019 – December 2019 and July 2020 – September 2021, excluding the public health emergency
  • Workforce management is critical to driving success and retention. Make sure to cultivate these areas:
    • Culture: Align your efforts with your vision and mission. Define your culture, which is the character and personality of your organization. What makes your organization unique?
    • Employee engagement: Most factors that drive engagement are non-financial. Employees want purpose and meaning from their work. The organization must work to develop and nurture engagement, which requires a two-way relationship between employees and employers.
      • 49.5% of employees are not engaged and 16.5% are actively disengaged
      • How employees experience their workload has a stronger influence on burnout
      • Look for characteristics, such as a negative attitude, constant stress, procrastination or a lack of trust
    • Invest in onboarding, training and on-going mentorship programs
      • Hire employees based on how they fit into your organization vs. having the required skills
    • Technology
    • Telehealth and/or remote patient monitoring
    • Innovative staffing models that include technology, find new ways to serve and do not compromise quality
  • Survey readiness should become a priority, with the Hospice FY 22 Final Rule announcing harsher “enforcement remedies” for noncompliant organizations:
    • Hospice programs will continue to be surveyed, at minimum, every 36 months
    • Condition-level deficiencies that are not corrected may result in temporary management of the hospice and noncompliant programs
    • Civil monetary penalties charged daily, not to exceed $10,000 a day, with the suspension of an organization’s license allowed to happen concurrently
    • Suspension of payment for new admissions


  • Identify the largest growth opportunity for your organization: When assessing your referral to admission process, creating a diverse portfolio can drive a more balanced length of stay and consistency in referral and admission patterns. For example, some organizations that did not have relationships with hospitals during the onset of the pandemic experienced a decrease in referrals as skilled nursing homes closed to partners. To develop a baseline and growth strategy, review referral and admission data by referral partner from your EMR, as well as Medicare claims data.
    • New physician relationships
    • Hospitals/long-term acute care (LTAC)
    • Skilled nursing
    • Assisted living facilities (ALF)
    • Continuing care retirement community (CCRC)
    • Home health organizations
    • Community
  • Review your conversion rate and identify your organization’s top five reasons that impact your Not Taken Under Care (NTUC) number. Develop a strategy to overcome the NTUC barriers to admission and reduce overall percentage for each reason.
  • Consider expanding into palliative care. During the public health emergency, millions of people could have benefited from interdisciplinary-centered palliative care.


  • Investing in mobile and cloud-based technology will enhance operations significantly and lead to improved processes in all areas of the organization:
    • Ease of use for staff engagement, higher satisfaction, speed to care
    • Regulatory enhancements that benefit from a global development team that work around the clock to update the software
    • Organization procedures are automated and optimized through workflows
    • Clinical intelligence
    • Built-in training and education
    • Control and flexibility
  • There are concerns that the value-based carve-in will limit the number of hospice providers for consumers to choose, dilute the hospice benefit, reduce reimbursement, become a barrier to care access and impact the scale of direct care being provided.
    • Hospices can partner with payers, understand what they value in the key performance indicators (KPIs) and fold them into their philosophy of care.
    • If you plan to participate in the value-based insurance design (VBID) demonstration, known as the Medicare Advantage (MA) hospice carve-in, understand the overall goals of the Center for Medicare and Medicaid Innovation (CMMI) VBID demonstration.
      • Opt in early to influence the scope of care delivery and payment model construction
    • Build strong relationships with MA plans that have a large market share in your area.
  • Reduce the risk of exceeding the hospice cap amount by developing a growth strategy to drive the length of stay (LOS) down.
  • How you influence accurate and clean cost-reporting practices will determine future payment rates. Cost reports also have a significant amount of information in them to help management better understand their business. The cost report has prescribed approaches to determining the costs of services, which creates a common approach that can be used to benchmark your operations against peer providers.
  • Keep an eye on cost management:
    • Labor management
    • Cost per patient per day (PPD) management
    • Contract re-negotiation: Providers should understand their costs of services, as this should be the starting point for any negotiation. A provider should at least seek to cover their costs in the payment rates they negotiate with these payers.
    • Durable medical equipment (DME) supplies and drugs

Axxess Hospice, a cloud-based hospice and palliative care software, includes regulatory updates built in and a wide-ranging report center updated in real time.


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