Every hospice in the country has a public star rating, and it lives on a website your hospice does not control. CMS posts it on Medicare Care Compare, the government's official comparison tool for hospice quality. Families use it to choose a hospice. Hospital discharge planners pull it up before deciding who to refer a patient to. If a hospice down the road has four stars and yours has three, that difference is doing work before a single phone call happens.
Most hospice leaders assume their star rating is a direct reflection of their clinical team: the nurses, the aides, the chaplains, the social workers. That assumption is only partly true, and the gap between what leaders think drives the score and what actually drives it is exactly why so many hospices are stuck at a rating lower than their care would suggest.
The hospice star rating comes from the CAHPS Hospice Survey, a questionnaire CMS mails to a bereaved family member roughly two months after a patient's death. The survey has 47 questions. Families answer based on their lived experience: how quickly someone responded when they called, whether the care team explained what to expect, whether the equipment in the home worked and showed up on time, whether they felt supported and respected.
Here is the part that surprises most hospice administrators: 40 percent of those 47 questions are tied, directly or indirectly, to the hospice's equipment vendor. Not the nurse. Not the chaplain. The company that delivers the hospital bed, the oxygen concentrator, and the wheelchair, and whether that company shows up when it says it will.
A family does not separate "the hospice" from "the equipment company" in their mind. If a hospital bed arrives six hours late, or a concentrator breaks down at 2 a.m. and nobody answers the phone, the family experienced that as a failure of the hospice, full stop. It shows up on the survey as a lower score for the hospice, even though the hospice's own clinical staff may have done everything right.
Most hospices do not track equipment vendor performance the way they track clinical metrics. There is no dashboard showing how many deliveries were late last quarter, or how many families waited more than an hour for equipment support after hours. Without that visibility, a hospice can genuinely believe its care is excellent and still watch its CAHPS score sit at three stars, because the piece it cannot see is the piece pulling the score down.
This is also why star ratings tend to be stickier than leadership expects. A hospice can hire a wonderful new clinical director, retrain its whole nursing staff, and still see the score barely move, because the operational issue was never on the clinical side to begin with.
Two pressures are converging on hospice leaders right now. Medicare's payment increase for hospice is 2.6 percent in 2026, well below the pace of rising costs, which means every controllable expense line matters more than it did a year ago. At the same time, star ratings are getting more visible, not less, as families and hospital systems lean harder on Care Compare before making referral decisions. A hospice sitting at three stars today is not just losing a few families at the margin. It is losing referrals it never even hears about, because a discharge planner quietly chose the four-star hospice down the road instead.
The good news is that because so much of the score rides on equipment performance, it is also one of the more fixable pieces. Unlike staffing shortages or wage pressure, vendor accountability, delivery timelines, and after-hours response are operational problems with operational solutions.
Before changing anything, it helps to see exactly where the gap is. A free CAHPS Self-Assessment Worksheet, mentioned again below, walks a hospice administrator through scoring their current equipment vendor across the six survey categories most tied to DME performance, covered in more detail in The 6 Survey Categories Your Equipment Vendor Controls. It takes about ten minutes and produces a simple risk score you can bring into your next leadership meeting.
If you want the fuller data behind the 40 percent figure and how hospices have closed that gap, the CAHPS Whitepaper breaks down the pre- and post-improvement numbers in detail.
This is exactly the gap Qualis was built to close. Qualis is a DME Benefits Manager for hospice, palliative care, and PACE organizations: an EMR-integrated ordering portal paired with a managed national vendor network, not just a portal on its own. When a nurse orders a hospital bed or an oxygen concentrator, the order routes to an accountable vendor in Qualis's network, gets tracked in real time from placement to delivery, and rolls up into one consolidated invoice for leadership instead of a stack of mismatched vendor bills.
Qualis, now part of the LivTech family of in-home care solutions, does not own, rent, or sell any of the equipment it manages, so its only incentive is getting the right equipment to the bedside on time and holding the vendor accountable when it does not. Hospices working with Qualis are not waiting for a survey to come back three months later to find out a delivery was late. They can see it happening, and fix it, in real time.