Hospice Quality

National Hospice Locator – Sixth Quality Score Update
Posted October 14, 2025; updated 2/5/26

Based on feedback from hospice leaders nationwide, the sixth update of the hospice quality score calculation was uploaded on October 14, 2025. This update incorporates the most recent CMS Care Compare quality files (August 2025 release). Details on how individual hospice scores has been added.

Background
Since April 12, 2023, the National Hospice Locator has provided the public with free, comprehensive information about every known hospice location in the United States - now default-sorted by quality. This marks the first (and only) publicly available national ranking of all hospices by quality.

Why Hospice Quality Matters
Hospice quality is important - yet often difficult to define, measure, or report. With input from hospice leaders across the country, Hospice Analytics developed a quality ranking tool designed to make these measures more transparent. While the concept of ranking is not new, making quality-based rankings for every hospice publicly accessible is unprecedented.

The Current Quality Scoring System
Hospice Analytics currently uses eight (8) weighted metrics derived from multiple Medicare data sources. These metrics are reviewed and recalculated as new information becomes available. Ongoing discussions with hospice leaders allow for metrics and weighting adjustments over time. As of the 6th update (October 2025):

• Quality scores range from 34 to 100 (out of 100 possible points).
• The mean and median scores are ~67.
• The 80th percentile score is ~84, meaning hospices scoring ≥84 rank among the top 20% nationally.
• Hospices with scores below 50 typically lack sufficient data for calculation.
• Notably, 12 hospices achieved a perfect score of 100 in this update. Congratulations:
• Avow Hospice, FL
• Hospice of Central Ohio, OH
• Brite Health Services, TX
• Alpha Omega Hospice, TX
• Angels Grace Hospice, IL
• Miracle City Hospice, OH
• Hospice Alliance, WI
• Hospice of Lenawee, MI
• Hospice of Miami County, OH
• Dixie Hospice Care, UT
• AseraCare Hospice, NE
• Kare in Home Hospice of Ridgeland, MS

The Eight Current Quality Metrics:

1. Hospice Visits in the Last Days of Life - from the Hospice Item Set
1. Maximum points: 20
2. Why it matters: Expert care and frequent visits from hospice staff (nurses, aides, etc.) in the final days or hours of life help manage pain, provide comfort, and support families during an emotional time.
3. How points are awarded: All hospices nationwide are sorted into five equal groups (quintiles) based on their performance. The top 20% earn full points (20/20); the next 20% earn 85% (17/20); then lower groups get less. Hospices with no data or very low performance get 25% (5/20).
2. Staffing Ratios - from hospice claims
1. Maximum points: 20
2. Why it matters: The amount of time trained hospice staff spend directly with the patient and family shows commitment to hands-on care, symptom management, and emotional support.
3. How points are awarded: CMS calculates average staff visit minutes per patient day. Hospices are divided into five equal national groups. Top group gets 20/20; next gets 17/20; and so on. No data earns 5/20.
3. Levels of Care - from hospice claims
1. Maximum points: 20
2. Why it matters: Medicare recognizes four levels of hospice care (routine home care, continuous home care, general inpatient care, and respite care). Offering all four shows the hospice can meet patients' changing needs — from basic support at home to intensive crisis care when symptoms worsen.
3. How points are awarded: Hospices earn 25% of the points (5/20) for each of the four levels they provide during the measurement period. Full points require providing all four.
4. "Would Definitely Recommend This Hospice" - from the Hospice CAHPS survey
1. Maximum points: 20
2. Why it matters: This question captures overall family satisfaction. When caregivers say they would "definitely" recommend the hospice, it reflects high-quality, compassionate care during a difficult time.
3. How points are awarded: Hospices with 85% or more "definitely recommend" responses earn full points (20/20). Those below 85% earn 75% (15/20). No survey data earns 50% (10/20).
5. Stability (six years certified & ownership changes) - from the CMS Provider of Service File
1. Maximum points: 10
2. Why it matters: A stable hospice (same ownership for at least six years, covering two full certification cycles) tends to have consistent leadership, experienced staff, and reliable processes — all of which support better care quality.
3. How points are awarded: Six or more years of stability earns full points (10/10). Anything less earns 60% (6/10).
6. Accreditation - from the CMS Provider of Service File
1. Maximum points: 5
2. Why it matters: Accreditation by an independent organization means the hospice voluntarily meets extra quality standards and undergoes specialized reviews beyond basic Medicare requirements. It signals a commitment to excellence.
3. How points are awarded: Accredited hospices earn full points (5/5). Unaccredited ones earn 60% (3/5).
7. Health Equity (any Medicaid) - from hospice cost reports
1. Maximum points: 5
2. Why it matters: Hospices that care for people with Medicaid (in addition to Medicare) show they serve diverse communities, including lower-income patients who may rely on Medicaid coverage. This promotes fair access to end-of-life care.
3. How points are awarded: Reporting any Medicaid patient days earns full points (5/5). No Medicaid days earns 60% (3/5).
8. Waste, fraud, or abuse penalty - new as of 10/25 - from CMS / Office of the Inspector General (OIG)
1. Maximum points: -15 (a penalty that subtracts points)
2. Why it matters: Hospice care depends on trust. Any involvement in waste, fraud, or abuse harms patients, families, and the Medicare program. CMS (and we) has zero tolerance here.
3. How points are awarded: Hospices indicted or convicted by the Office of Inspector General (OIG) lose 15 points. All others are unaffected (no change).

Why Now?
For decades, hospice quality has been debated but rarely measured in a way that the public can easily access or understand. Sharing quality rankings openly carries some risk - likely one reason it has never been done before. However, recent increases in the number of hospice providers and public scrutiny of the field have created confusion about how to choose a hospice. In alignment with our mission to increase access to and utilization of high-quality hospice care, Hospice Analytics developed this ranking system to guide families and communities toward trusted providers.

About the National Hospice Locator
Launched in 2012, the National Hospice Locator helps individuals find hospice providers in their area and now averages 15,000+ monthly visits and searches. Historically, the Locator displayed results sorted by hospice census - the largest hospices appearing first under the assumption that size correlated with service depth. Beginning April 12, 2023, the default sort order changed to prioritize quality scores, offering a more meaningful measure of excellence. Users can still choose to sort results by hospice size or other factors.

These metrics were applied consistently to all US hospices - reflecting our commitment to fairness, trustworthiness, and ethical integrity. For questions, suggestions, or feedback, please contact Hospice Analytics at: Info@HospiceAnalytics.com.

Hospice quality matters - and the time is now.