Empassion CEO: Palliative Care Significantly Impacts Payer Star Ratings

Why It Matters

Star ratings directly determine Medicare Advantage reimbursement, so even small rating shifts translate into massive financial outcomes; the certification gives payers a tool to ensure quality and reduce costly fraud.

Key Takeaways

• Palliative visits excluded from star rating calculations
• Exclusions can boost plan ratings, saving hundreds of millions
• Empassion Assured certifies hospice quality for payer networks
• Certification helps identify good providers, curb fraud
• CMS may shift toward integrating palliative metrics soon

Pulse Analysis

The CMS star‑rating system has become a financial lever for Medicare Advantage plans, with each half‑star swing influencing billions in annual reimbursements. By carving out patients who receive palliative‑care visits, plans avoid penalizing their overall scores for a population that often struggles with routine quality measures. This exclusion, however, creates a hidden incentive: plans must still manage these high‑risk patients effectively to prevent complaints and readmissions that could indirectly affect their ratings.

Empassion Health’s new Empassion Assured certification addresses a market gap by offering an independent, data‑driven badge for hospice agencies that meet stringent quality, compliance, and outcome criteria. Payers can now differentiate top‑performing providers from low‑quality or fraudulent operators, facilitating the creation of preferred hospice networks. For providers, the badge serves as a marketing asset, strengthening negotiations with payers and boosting referral volume while protecting patient choice.

Looking ahead, industry observers anticipate that CMS may refine its star‑rating methodology to incorporate palliative‑care metrics, moving beyond simple exclusions toward a more nuanced assessment of end‑of‑life care. Such a shift would reward plans that integrate comprehensive palliative services, aligning financial incentives with higher‑quality, patient‑centered care. The certification model pioneered by Empassion could become a template for broader quality‑based network design, influencing policy, reducing fraud, and ultimately improving outcomes for the most vulnerable Medicare beneficiaries.