In its March 2025 report to Congress, the Medicare Payment Advisory Commission (MedPAC) provided a detailed look at the state of hospice care, highlighting both the stability and ongoing challenges in the sector. Regarding hospice quality care, the report underscored that while quality of care remains difficult to measure comprehensively, existing indicators such as the…
In its March 2025 report to Congress, the Medicare Payment Advisory Commission (MedPAC) provided a detailed look at the state of hospice care, highlighting both the stability and ongoing challenges in the sector. Regarding hospice quality care, the report underscored that while quality of care remains difficult to measure comprehensively, existing indicators such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) hospice survey and various process measures point to generally stable performance across the industry.
CAHPS scores, which reflect the hospice experiences of patients’ caregivers, have held steady in recent years. Between January 2022 and December 2023, 82% of caregivers rated their hospice a 9 or 10 out of 10, and 85% said they would definitely recommend the hospice. These numbers are unchanged from the prior period. Caregivers gave the highest marks for emotional support and respect, with 91% selecting the most positive rating in these categories. Rural hospices continued to outperform their urban counterparts by 2 to 5 percentage points across key measures. Additionally, ownership status also played a role in perceived quality: nonprofit hospices consistently scored higher than for-profit providers, a finding supported by several recent studies.
MedPAC also noted areas for concern. About 10% of caregivers reported poor experiences with pain and symptom management or timely help. This is concerning as these metrics are critical to hospice’s mission.
Process measures, which assess key steps hospices should take at admission, remained extremely high. Hospices performed well on CMS’s composite measure, with the median provider scoring 96.6% (slightly up from 96.2% the previous year). However, MedPAC acknowledged that such high scores indicate these measures may have “topped out,” offering little differentiation between providers.
A newer focus has been on in-person visits at the end of life, which are seen as vital for symptom control and support. While visit frequency and visit time lengths by nurses and social workers stabilized or slightly increased in 2023, they have yet to fully rebound to pre-pandemic levels. Notably, in-person nurse visits in the last week of life remained less frequent than in 2019, though visit time lengths were slightly longer.
The report also touched on CMS’s implementation of the Hospice Special Focus Program, aimed at identifying and addressing poor-performing hospices. Launched in late 2024, the program flagged hospices with serious quality issues for intensified oversight. However, in February 2025, CMS paused the program to further refine its approach. This pause will allow CMS to focus its ongoing efforts to ensure it effectively targets real quality concerns.
Looking ahead, MedPAC continues to advocate for outcome-based quality measures, which it believes would offer a more meaningful assessment of hospice care than the current process-heavy framework. The forthcoming Hospice Outcomes & Patient Evaluation (HOPE) instrument, set to roll out October 1, 2025 (FY2026), promises to be a step in this direction by collecting richer data throughout the hospice episode.
Finally, MedPAC flagged rising live discharge rates as a potential red flag. In 2023, 18.5% of hospice discharges were live discharges (up from 17.3% in 2022). While some discharges are expected due to patient improvement or personal choice, persistently high rates particularly among certain providers could suggest issues with the quality of care provided or questions regarding hospice eligibility and appropriateness.
In summary, the hospice sector remains stable in many respects, with high scores in caregiver-reported satisfaction and process compliance. However, MedPAC’s report highlights the need for deeper, more nuanced quality measures and continued vigilance over provider practices to ensure that the promise of quality hospice care is fully realized for all patients and families.
Reference to MedPAC report: March 2025 report to the Congress–Chapter 9: Hospice services
