5 Questions With James Dismond on the Hospice Special Focus Program

On Feb. 14, the Centers for Medicare & Medicaid Services (CMS) announced its decision to halt the implementation of the Hospice Special Focus Program (SPF). CMS said the goal of the program was to address issues that could place hospice beneficiaries at risk of receiving poor quality of care. It also said hospice programs that could not resolve the “deficiencies that brought them into the SFP” could be terminated from the Medicare program.

The SPF was met with pushback from the hospice industry, and a group of hospices and state and regional hospice associations sued CMS in January over the program, saying the agency used misleading or inaccurate data that failed to distinguish fraudulent and quality providers and overly penalized well-established hospices.

HomeCare spoke with James Dismond, CEO of MiraSol Health, a hospice and palliative care organization that has been providing care for more than 42 years, about the negative impacts that hospice providers would have seen with the implementation of SPF and how it should be reapproached should CMS revisit it.

HomeCare: What impact do you believe the SFP would have had on hospice providers?  

James Dismond: The issue wasn’t with the intent of the SFP, it was how it was to be implemented. The program placed undue scrutiny on hospices, including those that are committed to meeting patient needs and maintaining high-quality care standards.  

Families dealing with serious illness or loss deserve a peaceful, compassionate environment without the added stress of bureaucratic hurdles. The SFP made it harder for providers to stay focused on that mission. 

With the SFP now suspended, we have an opportunity to reassess and ensure that future oversight measures are both effective and fair, supporting quality care rather than obstructing it. 

HC: How would have the SFP challenged your organization specifically?  

Dismond: At nonprofit hospices like MiraSol Health, we serve all patients regardless of financial circumstances. In many cases, this means individuals without family support or other means of supportive resources. The SFP has forced us to redirect internal resources toward compliance and administrative reporting, which if the SFP continued in the direction it was headed, would eventually cause nonprofits like us to redirect funds operationally taking away from patient care and creating more barriers for access to care.  

HC: What changes would you like to see in the SFP?

Dismond: I would suggest revisiting the structure of the SFP to create a more balanced approach that supports providers without undermining the very work they are doing to help patients and families. The algorithm is not weighted fairly for all organizations, specifically putting pressure on larger entities and entities experiencing growth. Smaller entities or those who operate multiple locations with smaller censuses often fly under the radar regardless of the quality of care and measurable outcomes.  

A more collaborative approach between regulators and providers will ultimately better serve patients. For example, prioritizing taking a more proactive approach to investigating fraud reports might be a better use of resources rather than imposing another audit for all providers.  

The program could be more effective if it incorporated flexibility and understood the context of individual hospice organizations, allowing them to address challenges with the proper resources. 

Regulators need to understand the barriers we face as providers and our patients face to better operate as one for better positive outcomes.  MiraSol Health embraces change in regulations when the outcome supports better patient outcomes. 

HC: What message would you like to send to lawmakers/regulators about the current state of hospice care under the SFP?

Dismond: The Trump administration’s decision to suspend the SFP was a necessary step toward reevaluating how we regulate hospice care. Oversight should ensure quality, but it must be implemented in a way that does not hinder the ability of providers to deliver compassionate end-of-life care. 

Now that the program is suspended, I urge policymakers to engage with hospice providers to create a regulatory environment that helps them instead of burdening them. However, it is important for all of us to realize the unprecedented fraud and corruption that is taking place by largely for-profit entities backed by private equity companies and the importance of investigating each claim proactively.  

It’s time for providers to be able to teach and regulators to listen to the barriers and needs. Open up hospice assessments to more than just RNs (registered nurses); we have highly trained LPNs (licensed practical nurses) that could drastically aid our care models. Permit medical assistance and resident aides to provide care in all states and be included in the reimbursement models similarly to senior care facilities. Our care teams are well-trained and ready for a larger impact. 

HC: What advice do you have for other hospice providers navigating the challenges posed by the SFP? 

Dismond: While we support accountability in hospice care, we must also advocate for fair and effective oversight policies. Hospice providers should stay informed, work with their industry associations, and share best practices to ensure that any future regulatory efforts are both just and beneficial. 
The suspension of the SFP gives us a chance to push for meaningful reforms. By working together, we can ensure that oversight efforts truly serve the best interests of patients, families, and providers.