How CON Laws Influence Hospice Quality, Program Integrity [Featuring HHAC]

Hospice News / By Holly Vossel

Variations in hospice certificate of need (CON) state laws are raising program integrity concerns.

However, this coin has two sides. CONs have a big role to play when it comes to quality and utilization, according to Susan Ponder-Stansel, president and CEO of Florida-based Alivia Care.

“What ends up happening in states without CON is actually lower hospice utilization with way too many hospices in one service area, and often fragmented care without all four levels of hospice offered,” Ponder-Stansel told Hospice News. “In states with CON, we see much higher utilization rates and more scaling down on quality. You can’t create an unlimited demand or more demand without understanding consumer preferences and regulatory barriers. You have to walk in line with the [patient] demand and regulatory requirements.”…

If a state does not have a CON program in place, then local governing bodies are often unable to play a direct role in the hospice needs determination process, according to Matt Hansen, deputy director of the Home Care and Hospice Association of Colorado (HHAC). Hansen also serves as executive director of the Homecare & Hospice Association of Utah (HHAU).

“They may be aware of a need due to reports from referring parties that they aren’t able to find a provider. However, approving a new license is not based on how many providers are already in an area,” Hansen said.

Without having a role in the determination process, it can make it difficult to balance quality with supply and demand of hospice in a region, according to Hansen.

“Demand and supply of hospice resources is balanced by market conditions,” Hansen said. “If there are too many hospices in an area to meet current demand, those hospice agencies that do not have a large enough referral base and patient census will typically flounder until they sell to another provider or close.”

Read Full Article