As never before, long-term care operators are reinventing their business models.
Many of the portfolio expansions make sense as a way to better meet customers’ needs. Add assisted living? Why not? The same might also be said of home health services.
Hospice care? Well, maybe not so fast.
At first glance, hospice would seem to be a natural fit for long-term care. After all, this service focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching life’s end. Skilled care is practically a feeder program for this profile.
Moreover, Medicare tends to reimburse hospice care providers quite well.
So why should skilled care facilities proceed with caution here? Because the feds are increasingly cracking down on rampant fraud and abuse in hospice.
In fact, the Centers for Medicare & Medicaid Services just placed new hospices in Arizona, California, Nevada and Texas under enhanced oversight due to escalating reports of nefarious profiteering.
The stepped up oversight applies to any new hospice, a hospice submitting a change of ownership (CHOW), or a hospice undergoing a 100% ownership change that doesn’t fall under a CHOW. Enhanced oversight will last anywhere from 30 days to one year and can include prepayment reviews, additional visits for providers not billing, and possible deactivation of the hospice’s provider number, according to the National Hospice and Palliative Care Organization.
Of course, these four states are just the hotbeds. You can be sure CMS is keeping a close eye on suspicious billing practices in other states as well.
So it would probably be in any long-term care provider’s best interest to avoid getting pulled into that quagmire. Especially now.
It’s no secret the White House already views nursing homes with more than a modicum of suspicion. President Biden actually called out operators for poor care in a State of the Union address.
Administration concerns about care quality are also fueling the push for staffing mandates in nursing homes.
So given this, ahem, environment of suspicion, it might be good business for skilled care operators to move carefully into hospice care. If at all.
That is, unless your organization is really into frequent audits and inspections.
John O’Connor is editorial director for McKnight’s.
Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.
