WASHINGTON — The National Partnership for Healthcare and Hospice Innovation on June 16 issued a statement calling for a reformed Medicare hospice payment model that better compensates providers delivering the highest quality care, while pushing back against a federal watchdog’s recommendation to restructure reimbursement around per-visit billing.
The statement came one week after the U.S. Government Accountability Office published a report — GAO-26-107585 — documenting wide disparities in care volume across hospice providers and concluding that Medicare’s flat daily payment rates may be rewarding low-effort providers at the expense of program efficiency and patient welfare.
“The current structure was developed decades ago and does not fully reflect the realities of caring for today’s hospice patients,” said Tom Koutsoumpas, founder and CEO of NPHI. The payment system, he said, presents “an opportunity to better reward providers caring for patients with the greatest needs.”
GAO Finds Medicare Paying Low-Visit Hospices Twice as Much Per Visit
The GAO’s June 9 report analyzed Medicare claims for more than 1.2 million beneficiaries discharged from hospice in 2024, across 4,340 providers. The findings revealed a striking divide in service intensity: the bottom 20 percent of hospices by visit volume delivered an average of approximately 2.5 visits per week per beneficiary, while the top 20 percent averaged 5.5 visits. Under the current flat daily rate structure, Medicare paid both groups at the same rate.
“Medicare effectively paid low-visit hospices twice as much per visit as high-visit hospices, on average,” the report stated.
The GAO estimated that Medicare would have paid approximately $9.1 billion for the same group of beneficiaries had routine home care been billed under home health per-visit rates — a $7.6 billion difference from the $16.7 billion actually paid between 2022 and 2024. Total Medicare hospice spending reached $27.5 billion in fiscal year 2024, nearly double the $15.5 billion spent in 2015.
The agency recommended that Congress consider directing the Department of Health and Human Services to revise hospice payment methodology for routine home care services “to better promote payment efficiency and realize savings for the Medicare program.”
NPHI Warns Against Per-Visit Reimbursement Model
While NPHI welcomed a broader discussion on payment modernization, the organization said it holds “serious questions regarding the approach” outlined in the GAO report, warning that shifting to per-visit reimbursement could “result in broad reimbursement reductions for hospice providers nationwide.”
Ethan McChesney, NPHI’s senior policy director, disputed the analytical framework underlying the GAO’s methodology. “Hospice is fundamentally an interdisciplinary model of care built around meeting patient and family needs, not a collection of individually billable visits,” McChesney said.
Instead, NPHI outlined three reform priorities it believes would strengthen incentives without cutting off access to care: reducing the hospice aggregate cap to discourage low-intensity providers; reallocating existing payment dollars within the current methodology to better compensate mission-driven providers serving the most complex patients; and establishing pathways for hospices to share in the Medicare savings they generate relative to hospital-based care.
Congressional Reform Efforts Accelerate
The NPHI statement arrives amid intensifying congressional interest in hospice payment and program integrity. In March 2026, Rep. Linda T. Sánchez (D-Calif.) and Sen. Mark Warner (D-Va.) reintroduced the Hospice Care Accountability, Reform, and Enforcement (CARE) Act, which would revise routine home care payment structures to reward in-person visit delivery, increase reimbursement for high-acuity palliative interventions including radiation, chemotherapy, blood transfusions, and dialysis, and create an outlier payment policy to provide a financial backstop for providers serving exceptionally high-cost patients.
NPHI expressed support for the legislative direction while noting certain payment provisions would benefit from further stakeholder refinement.
Earlier in June, NPHI also endorsed H.R. 8883, the Protecting Seniors and Stopping Fraudsters Act, introduced by Rep. Beth Van Duyne (R-Texas), which would tighten oversight of newly enrolled hospice providers, increase penalties for quality data non-reporting, and require the Centers for Medicare & Medicaid Services to regularly disclose its audit and enforcement activities to Congress.
For fiscal year 2027, CMS has proposed a 2.4% payment rate increase for hospice providers — a figure NPHI and other industry advocates have called insufficient to sustain quality care delivery as program scrutiny intensifies.
Why This Matters for Home Care
For families who have chosen to bring a loved one home under hospice care, questions about how Medicare pays for that care — and whether providers are being appropriately rewarded for the time and attention they invest — have direct implications for the quality of support families can expect to receive. A payment system that better aligns reimbursement with actual care intensity gives providers a stronger incentive to show up, to stay, and to address the full range of a patient’s comfort needs at home.
Ensuring that the home environment itself is equipped for this level of care is equally important. For families supporting a loved one through hospice or palliative care at home, SonderCare’s home hospital beds are designed to provide the clinical positioning and safety features that support comfortable, dignified end-of-life care without turning a bedroom into a clinical space.
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Sources: National Partnership for Healthcare and Hospice Innovation; U.S. Government Accountability Office (GAO-26-107585); Hospice News.
