Racial Composition and Single-Input Dominance in the First Hospice Special Focus Program Cohort
Wenhan Guo, Yusheng Jia, Zijing ChengBackground
Federal quality oversight increasingly uses composite algorithms built from administrative counts and caregiver-reported experience, but are rarely tested against actual enforcement cohorts. In December 2024, the Hospice Special Focus Program (SFP) selected 50 hospices for intensified oversight and possible Medicare termination; the program was paused in 2025 amid litigation.
Objectives
To assess associations between SFP selection and hospice size, patient racial composition, and independently measured quality, and whether selection reflected broad or narrow underperformance.
Methods
Cross-sectional analysis of all 7115 active hospices in the November 2024 CMS Provider Data Catalog. Selection was modeled with logistic regression adjusting for size, ownership, patient mix, and Hospice Visits in the Last Days of Life (HVLDL), a publicly reported measure not used by the algorithm. Composite scores for the 50 selected hospices were decomposed into standardized inputs.
Results
Selected and non-selected hospices did not differ in size (median, 152 vs 134;
Conclusion
SFP selection identified hospices with worse independent quality but usually reflected a single input and disproportionately affected Black-serving hospices.