*This article was written in consultation with Mariam Treystman.
Compliance is the difference between your agency thriving or facing devastating fines, failed surveys, and lost referrals. Managing a home health or hospice agency can feel like balancing on a tightrope. Except the tightrope is on fire, and you’re balancing a stack of Medicare Conditions of Participation on your head.
Between providing exceptional patient care, managing staff, and navigating industry regulations, it’s easy for compliance to get pushed aside. But neglecting compliance can lead to severe consequences.
At The Home Health Consultant, we've worked with hundreds of agencies to get them through surveys, applications, and more. In doing so, we've found that neglecting compliance is often the root cause of:
- Survey Failure
- Unexpected Regulatory Visits
- Decrease in Referral Sources
- Patient Safety Incidents
- Legal Challenges
- Provider Termination
Agencies that prioritize compliance face fewer operational issues and tend to achieve greater stability, longevity, and financial success.
In this article, we’ll explain:
- What compliance actually looks like
- Why a strong compliance program is essential for every agency
- A breakdown of what non-compliance can cost you
- The unique challenges of maintaining compliance in home-based care
- Why compliance with CMS regulations is essential to patient safety
- How compliance is directly tied to your agency's success
- How and why agencies may fall behind on compliance
- Next steps to take if you're looking for compliance support
By the end of this article, you'll know exactly what compliance is and why it's so much more than just a buzzword used by regulatory bodies.
What Does Compliance Look Like in Home Health and Hospice?
Compliance, at its core, means adhering to legal and regulatory requirements. It sounds straightforward, but in practice, it’s far from simple.
Compliance encompasses all aspects of running your agency, including managing patient care, meeting staffing requirements, and submitting accurate billing. Almost every essential task your agency must handle is likely connected to compliance.
During the initial Medicare certification process, maintaining compliance is relatively easy. This is due to the limited patient census and shorter timelines before the first survey. As agencies grow, so do their complexities.
Managing a larger census doesn’t just mean more money in your pocket. It also means:
- Juggling new staff
- An increase in referral sources (great if you're prepared, disastrous if you're not)
- Budget constraints
- Vendor reliability issues
- An increase in urgent care needs
For example, finding a nurse to visit a remote patient on short notice. Or the biller you hired did not keep up with this year’s changes, leading to claim denials. In the midst of all these pressures, it can be tempting to cut corners. But these shortcuts can quickly lead to significant problems.
Why Is a Compliance Program Crucial for Agencies?
It’s easy to feel like compliance is just another box to check. Another policy to review. Another survey to dread.
But compliance isn’t just busywork. It’s what keeps your agency, your patients, and your team safe.
Think about it. Even something that seems minor, like incomplete disaster plans or missed patient education, can snowball into serious problems. We’ve seen small oversights turn into survey condition-level findings, legal issues, or even provider termination.
Home health and hospice are so heavily regulated for a reason: to make sure no one is harmed in the process of care. That’s the true purpose behind compliance.
Yes, there are secondary goals too – like improving patient outcomes, preventing fraud, and fostering data-driven quality improvement. But at the end of the day, compliance exists to protect people.
What Do Compliance Lapses Actually Cost Your Agency?
Neglecting compliance in home health and hospice care isn’t just about regulatory risks. It can quickly become a financial disaster. Lapses in compliance lead to significant, and often unanticipated, expenses that strain agency resources.
Here's how costs can escalate:
- Resurvey Fees: If an accreditor requires a follow-up survey to address compliance issues, the costs can exceed $5,000 per survey.
- Payment Reductions: Noncompliance penalties can result in Medicare payment reductions of 6% or more, translating to tens or hundreds of thousands of dollars annually, for a typical agency.
- Application Errors: Submitting incorrect Medicare or health department applications wastes valuable time and can cost thousands in operational resources.
These costs don’t just impact your bottom line. They disrupt operations, increase stress, and hinder your ability to provide quality care. Proactively investing in compliance can prevent these financial pitfalls, ensuring your agency remains stable and profitable in a highly regulated industry.
Why Home-Based Care Poses Unique Safety, Supervision, and Resource Limitations
Unlike hospitals or skilled nursing facilities, home health & hospice services operate in patients' homes. With less structure and fewer daily interactions between staff and clinicians, agencies face unique challenges:
- Uncontrolled Environments: Unlike hospitals, where patient safety measures can be enforced, in-home care relies on patients and caregivers to implement safety guidelines.
- Limited Supervision: Clinicians work independently in the field, making it harder to ensure consistent adherence to protocols.
- Delayed Problem Detection: Agencies depend on self-reporting by patients and caregivers. This can delay the identification of issues.
- Resource Constraints: Clinicians in home settings often lack immediate access to supervisors, equipment, or emergency resources.
These challenges do not make maintaining compliance impossible. But it’s important to be aware of them as your agency grows so you can adjust your processes accordingly.
Why Compliance with CMS Regulations is Essential for Patient Safety
The regulatory framework for home health and hospice agencies has evolved over decades. CMS isn’t just adding rules to give you a headache. All federal and state regulations were created to respond to recurring problems.
For example, the introduction of mandatory Emergency Preparedness standards in 2018 was a direct response to dangerous situations created after Hurricane Katrina in 2005. These regulations aim to minimize risks and improve outcomes in complicated care environments.
How Does Compliance Drive Agency Success?
After reading the above, you should have a clear understanding of why compliance is crucial and how harmful it can be to underestimate its importance. Now let’s dive into the exciting part.
Prioritizing compliance doesn’t just mean avoiding disaster scenarios. There are major benefits that can transform an agency by:
- Promoting healthier, safer patient outcomes.
- Equipping staff with better education and resources.
- Reducing operational chaos and minimizing staff turnover.
- Protecting the agency from costly surveys, audits, or legal actions.
- Ensuring business stability through successful ADRs and surveys.
- Enhancing profitability by avoiding inefficiencies and errors.
Why Some Home Health & Hospice Agencies Fall Behind on Compliance
Despite its importance, many agencies push aside compliance until a survey. Pressing daily tasks like staffing, payroll, or patient care often take precedence. This leaves compliance efforts to the last minute.
This can, and does, happen. These agencies could be delivering exceptional patient care, but not have the internal resources to constantly maintain. But this reactive approach can lead to rushed, expensive fixes, stress, and significant operational disruptions.
Looking for Help Improving Your Home Health or Hospice Agency's Compliance?
Understanding the value of compliance is the first step toward reducing stress, improving patient outcomes, and ensuring long-term success.
Agencies ready to embrace a compliance program should start by exploring different structures and strategies to find the best fit for their operations.
By making compliance a cornerstone of daily operations, home health and hospice agencies can navigate regulatory challenges with confidence. This sets the stage for sustainable growth and profitability.
To read more about why we believe routine compliance maintenance is the best solution, check out the article below.
Or, if you're ready to invest in compliance support, check out the article below explaining our Administrative Compliance Program. You'll learn how it works, what you get, and be able to determine if our services are a good fit for your agency.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
Topics:
