We Are Using a Shotgun. Hospice Needs a Sniper

Lately, I can't scroll LinkedIn, Instagram, or Facebook without seeing it. Post after post about hospice. Fraud, waste, and abuse. The shifting landscape. The scrutiny. The headlines.

And while I appreciate that the conversation is happening — because silence has never served this field — I'm watching something happen in real time that worries me. The way we're talking about hospice right now is starting to do as much damage as the problems we're trying to fix.

So today I'm taking off my leadership hat and putting on my hospice hat. Because hospice is sacred to me. It is, quite literally, the work that shaped who I am. And I need to say a few things out loud.

The conversation is necessary. But the framing matters.

Yes, there is fraud, waste, and abuse in hospice. Yes, it is real. Yes, it must be addressed. None of that is in question.

What is in question is how we're talking about it — and whether the current narrative is unintentionally hurting the very thing it claims to protect.

Here's what I'm seeing:

• Legitimate hospices doing extraordinary work are getting lumped into the same category as the bad actors.

• Families who could benefit profoundly from the hospice benefit are now hesitating, because all they hear is "fraud" and "abuse."

• Clinicians and leaders who have built their careers on doing this right are facing scrutiny that wasn't designed for them.

• And the broader public, who already carries deep misconceptions about what hospice even is, is now layering distrust on top of that misunderstanding.

The hospice benefit is one of the most underutilized, under-discussed, and least understood benefits in American healthcare. Most people don't know what it actually covers. Most people don't know that early referral leads to better outcomes — not just for the patient, but for the entire family. Most people still believe hospice means "giving up," when in reality it often means finally getting the care that was missing all along.

We were already losing this conversation. And now we're at risk of losing it further.

Shotgun vs. sniper

Last fall I was in Washington, D.C., participating in the Alliance for Care at Home's Day on the Hill. One member of our group used a phrase that has stayed with me ever since — a phrase that captures everything I'm trying to say here in just a few words:

CMS is approaching fraud, waste, and abuse with a shotgun approach. What this moment requires is a sniper.

That's it. That's the whole problem in a sentence.

A shotgun sprays. It hits the target, but it also hits everything around it. A sniper is precise. It removes the threat without destroying the surrounding landscape.

The vast majority of hospices in this country are not the problem. The vast majority of clinicians, leaders, and organizations in this field are showing up every single day to provide some of the most meaningful care a human being can receive at one of the most vulnerable times of their life. They are not the few. They are the many.

We can root out bad actors without dismantling the trust we've spent decades building with patients and families. We can demand accountability without treating every hospice as guilty until proven innocent. We can have hard conversations about the problems without losing sight of the profound good this benefit provides.

But that requires precision. Not noise.

What we can actually do

If you work in hospice, lead in hospice, or have ever been touched by hospice — this is your moment to use your voice. Not later. Now.

Here's what that looks like:

• Write to your policymakers. Tell them what hospice actually looks like in practice. Tell them about the families you've served. Tell them what a sniper approach would mean — and what the current shotgun approach is costing.

• Share your stories. The good ones. The hard ones. The ones that show what early referral, skilled symptom management, and presence at the bedside really mean.

• Educate, openly. Talk about what the hospice benefit covers. Talk about who qualifies. Talk about the difference six months of hospice makes versus six days.

• Change the narrative without ignoring the problem. We can hold both truths at once. Fraud must be addressed and legitimate hospice care deserves to be defended.

• Refuse to let the bad apples define the orchard. Because they don't. They never have.

Why I'm writing this

I have lived inside this work. I have sat with families on their hardest days. I have watched my teams give something to people that no one else in the healthcare system was offering them. I have seen what hospice does — real hospice, done well — and there is nothing else like it.

The way we talk about this field shapes the way the public trusts it. The way we talk about this field shapes the policy that governs it. The way we talk about this field shapes whether the next family says yes to a referral or waits three more weeks they didn't have to wait.

So we keep talking. We keep telling the truth. We keep advocating — for accountability and for the integrity of the benefit itself.

A sniper, not a shotgun. Precision, not panic.

And until the conversation reflects that, I'll keep using my voice. I hope you'll use yours too.

Putting the leadership hat back on now. But the hospice hat never really comes off.