As conversations around hospice oversight and quality continue to evolve nationwide, Compassus CEO Mike Asselta and Providence Chief of Community Services Terri Warren have authored an op-ed exploring why accountability and access must go hand in hand. Published in McKnight’s Home Care, the piece highlights the importance of strong oversight, transparency and quality standards while ensuring patients and families can continue to access compassionate, high-quality hospice care. Together, the authors examine how thoughtful policy can strengthen trust in hospice and preserve this essential Medicare benefit for those who need it most.
Accountability and Access Must Coexist in Hospice Care
By Mike Asselta, chief executive officer of Compassus, and Terri Warren, chief of community services at Providence
Choosing hospice care often means inviting outsiders into some of the most intimate and vulnerable moments of a family’s life. That level of trust must be protected — not only through compassionate care, but through strong accountability and quality standards that ensure the Medicare hospice benefit works as intended.
As federal scrutiny around hospice oversight continues to intensify, conversations about fraud, abuse and inappropriate enrollment practices have understandably drawn national attention, particularly in states like California where regulators have identified troubling patterns among some providers. Organizations engaging in unethical or fraudulent behavior should be identified, held accountable and removed from the program. Patients and families deserve confidence that hospice providers are operating with integrity and delivering care grounded in quality, transparency and compassion.
At the same time, accountability and access should not be viewed as competing priorities. Patients and families deserve both.
Despite decades of evidence demonstrating the value hospice can provide to patients and caregivers, too many families still access hospice care only in the final days of life — or never access it at all. While hospice utilization has increased nationally over time, nearly half of Medicare beneficiaries still do not utilize the hospice benefit at the end of life. Among those who do, median hospice length of stay remains fewer than three weeks, limiting the ability of many patients and families to fully benefit from the emotional support, symptom management, caregiver guidance and interdisciplinary care hospice was designed to provide.
And hospice saves money for the Medicare trust, too. According to a 2023 NORC at the University of Chicago analysis of Medicare beneficiaries at the end of life, hospice users had 3.1% lower Medicare spending, or $3.5 billion less. Savings were even more pronounced among hospice stays of 15 days or longer. These findings are consistent with earlier research from Harvard University, federally funded studies supported by the National Institutes of Health and a 2024 study by Massachusetts Institute of Technology and Emory University demonstrating that timely hospice enrollment can improve care while reducing unnecessary end-of-life healthcare spending.
Far too often, hospice conversations begin only after repeated hospitalizations, escalating symptoms or treatments that no longer align with a patient’s goals of care. When that happens, patients and families lose valuable time for comfort, preparation, support and meaningful connection.
Trust in hospice care directly affects whether families feel comfortable accessing these services early enough to benefit from them.
That is why transparency and accountability matter so deeply.
The Centers for Medicare & Medicaid Services (CMS) has already strengthened hospice accountability by doubling penalties for providers that fail to meet quality reporting requirements. Congress is now considering legislation that would more than triple those penalties — a measure that Compassus and Providence support. Meaningful consequences for noncompliance help protect patients, improve transparency and reinforce the industry’s commitment to quality care.
Yet despite those stronger measures, CMS continues to report that approximately one in five hospices fail to meet required quality reporting standards. CMS has acknowledged that incomplete reporting limits the agency’s ability to accurately measure quality and reduces the information available to consumers making deeply personal end-of-life care decisions.
Quality transparency should not be optional in a healthcare model built on trust, accountability and patient-centered care. Patients and families deserve meaningful visibility into quality outcomes and care standards when choosing a hospice provider.
At the same time, oversight efforts must be thoughtful and data-driven enough to distinguish between organizations committed to long-term quality and those exploiting the system. Broad policy responses that fail to make that distinction risk creating unintended barriers to care for patients and families who rely on hospice services every day.
Across California and the country, many hospice organizations continue investing in clinical excellence, interdisciplinary care teams, compliance infrastructure, reporting systems and continuous quality improvement designed to strengthen patient trust and improve outcomes. Across the country, Compassus collaborates with health system partners to expand access to high-quality home-based care. Through care sites across California and the western United States, the Compassus and Providence partnership reflects that shared commitment to serving patients and families with compassion and excellence.
Hospice was created to ensure patients and families receive compassionate, person-centered care during the final chapter of life. At its best, it is one of the most compassionate and patient-centered models of care in medicine — focused not only on pain and symptom management, but also emotional support, caregiver guidance and improving quality of life for patients and families alike.
Patients and families should never have to question whether the hospice provider entering their home is guided by compassion, accountability and quality. Protecting the future of hospice care requires both strong oversight and strong providers committed to earning and maintaining that trust every day.
Oversight, transparency and compassionate end-of-life care are not competing priorities. Together, they help strengthen trust in hospice care and preserve an essential Medicare benefit for the millions of Americans who depend on it every year.
