(Alexandria, VA) – The National Alliance for Care at Home (the Alliance) today responded to a new report from the Government Accountability Office (GAO) recommending that Congress consider directing the Department of Health and Human Services to restructure the Medicare hospice payment system to better promote routine home care payment efficiency. The hospice benefit is both patient preferred and produces savings for the Medicare program. The GAO report highlighted that low-visit hospices are overwhelmingly concentrated in certain geographic areas that have been prone to fraud, waste, and abuse. The Alliance urges that efforts be directed at rooting out bad actors, whose data informed the GAO report and its findings, and ensuring legitimate, high-quality hospices can continue providing needed end-of-life care.
The GAO report asserts that shifting hospice to per-visit payment rates comparable to home health would have reduced Medicare spending by $7.6 billion for a selected group of beneficiaries in 2024. However, these savings are generated in part by paying less to “low visit” hospices that are concentrated in known high-fraud areas. Discussions of hospice reform should be focused on first stopping any fraudulent activity from wasting Medicare dollars, which would result in greater savings than those identified in this report.
The GAO report also fails to recognize the distinct differences between the home health and hospice benefit structures, regulatory requirements, and skillsets needed to deliver care. The hospice daily payment rate is a deliberate design that reflects the nature of hospice care. Unlike home health, hospice is a holistic, comprehensive benefit that includes all services needed for the palliation and management of a patient’s terminal condition, such as medication, supplies, equipment, skilled nursing, aide services, social work, chaplaincy, homemaker services, grief and bereavement support, physician visits, care coordination, and 24/7 on-call availability.
A 2023 study by NORC found that Medicare spending for patients who received hospice care was $3.7 billion less than it would have been had those patients not enrolled. More recently, a 2026 analysis conducted by ATI Advisory and commissioned by the Research Institute for Home Care found that if Medicare beneficiaries enrolled in hospice care just five days earlier, the program could save between $1.19 and $1.50 billion annually. These savings come from replacing costly hospitalizations, ICU stays, and aggressive curative interventions that do not align with patients’ goals with compassionate, coordinated care in the setting patients prefer.
The Alliance has long advocated for effective, targeted oversight to prevent fraud, waste, and abuse. We urge Congress to instead focus on rooting out fraudulent actors and enacting policies that protect and expand appropriate access to hospice care, such as strengthening the quality and integrity of the benefit and supporting earlier elections.
###
About the National Alliance for Care at Home
The National Alliance for Care at Home (the Alliance) is the leading authority in transforming care in the home. As an inclusive thought leader, advocate, educator, and convener, we serve as the unifying voice for providers and recipients of home care, home health, hospice, palliative care, and Medicaid home and community-based services throughout all stages of life. Learn more at www.AllianceForCareAtHome.org.
Press Contact
communications@allianceforcareathome.org
Hannah Kristan | 202-355-1647