Hospice providers are under the spotlight as regulators continue to ramp up their investigatory efforts to identify quality, compliance and other deficiencies in hospice care. Just recently, the Office of Inspector General (OIG) recommended that CMS strengthen the survey process as part of its guidance for improving the Medicare hospice program.
With so much focus on hospice care, how confident are hospices in their ability to respond to regulators? We explored these and other questions in a survey that looked at challenges hospice providers face as they look to comply with regulations.
The independent survey of more than 170 hospice agencies found that nearly half (46%) of respondents showed a lack of full confidence in their ability to survive a federal audit without facing potential penalties, fines or loss of productivity that could financially impact their business.
Regulatory scrutiny of hospice claims was also cause for concern—and doubt. 42% expressed uncertainty about their ability to successfully respond Additional Documentation Requests (ADRs), which are used by auditors to review hospice claims.
Clinical documentation is vulnerable
Clinical documentation proved to be a key area of vulnerability. 94% of hospices surveyed said the way they currently manage clinical documentation needs improvement, and that weaknesses in their approach are negatively impacting many areas of their businesses, including clinician productivity/efficiency (82%), speed of reimbursement (60%) and compliance with regulations (59%).
“When you think about growing regulations, billing and the payer mix, it all comes down to how well documentation is being done on the front end by the bedside,” commented Jonathan Skypek, Optima’s VP of hospice care. “The bottlenecks that inefficient documentation create on the front end can lead to problems on the back end with compliance—and place an enormous burden on hospice clinicians and staff.”
Hospice-specific software improves confidence levels
Greater regulatory oversight will require hospices to evaluate how technology, best practices and other approaches can address documentation vulnerabilities and reduce risk. The survey findings show that greater use of hospice-specific software can help.
Agencies that use hospice software to manage all of their main functions—intake/referral, scheduling, documentation, quality and billing—were significantly more confident in their ability to survive an audit (71%) and successfully respond to ADRs (68%).
“Hospices using a variety of disparate systems to manage their agency can run into challenges because information is siloed, and parts of the business don’t communicate with each other,” added Skypek. “Additionally, systems adapted from other healthcare environments for hospices can be cumbersome to use, forcing clinicians to create workarounds to properly document care.”
In fact, the survey results showed that 57% of respondents are often forced to answer non-hospice-related questions (i.e. OASIS) when documenting care.
“The need for integrated hospice-specific software solutions makes sense—not only from a regulatory standpoint, but to help hospices attract the best talent and be more competitive,” said Skypek.
To read the full survey results, download the free report.