MedPAC: March 2026 Report to Congress
MedPAC Reports; 3/12/26
Medicare Benefit: National health care spending grew rapidly in 2023 and 2024, by 7 percent in each of these years. By 2024, national health care spending totaled $5.3 trillion. Health care spending has made up an increasing share of the country’s gross domestic product (GDP) over time, rising from about 13 percent of GDP in 2000 to 18 percent in 2024. Medicare spending grew more rapidly than national health care spending in 2023 and 2024 (by 9 percent and 8 percent, respectively), in part due to changes in Part D financing that shifted more of the cost of prescription drug coverage from beneficiaries to the federal government. By 2024, Medicare spending totaled $1.1 trillion—equivalent to 21 percent of national health care spending and 3.8 percent of GDP. (Please see the full report here for additional detail.)

Hospice Chapter here. Highlights include:

• For fiscal year 2027, the Congress should eliminate the update to the 2026 Medicare base payment rates for hospice.
• In 2024, more than 1.8 million Medicare beneficiaries (including more than half of decedents) received hospice services from about 6,700 providers, and Medicare hospice expenditures totaled $28.3 billion. 
• The share of decedents using hospice increased to 52.9 percent in 2024, up from 51.7 percent in 2023, reaching a new high.
• The aggregate FFS Medicare margin for 2023 was 8.0 percent, down from 9.8 percent in 2022. In 2024, cost growth slowed, with hospices’ average cost per day increasing by 1.1 percent. The projected 2026 FFS Medicare margin is 9 percent.

• Calculations based on Tables 10-1, 10-8, and 10-9 (based on 6,706 total hospices in 2024):

• For profit hospices accounted for 82% of hospices (N= 5,497) in 2024; average total cost per day= $147; FFS margin= 13.7% in 2023.
  Nonprofit hospices accounted for 16% of hospices (N= 1,070) in 2024; average total cost per day= $214; FFS margin= -1.3% in 2023.
  Government hospices accounted for 2% of hospices (N= 130) in 2024.
  Urban hospices accounted for 88% of hospices (N= 5,877) in 2024; average total cost per day= $170; FFS margin= 8.3% in 2023.
  Rural hospices accounted for 12% of hospices (N= 829) in 2024; average total cost per day= $156; FFS margin= 5.3% in 2023.

Call for applications: Investigator in Residence Program
ASCENT press release; 3/2/26
The Advancing the Science of Palliative Care Research Across the Lifespan (ASCENT) Consortium invites applications for its 2026 Investigator in Residence Program. The goal of this program is to increase the number of palliative care investigators, expand the range of institutions where palliative care research is performed, and develop scientific and leadership capabilities leading to future successful grant proposals, both through ASCENT and extramurally. Applications due Thursday, March 26 at 5:00 pm PT.

What does moral agency mean for nurses in the era of artificial intelligence?
Hastings Center Report; by Connie M Ulrich, Oonjee Oh, Sang Bin You, Maxim Topaz, Zahra Rahemi, Liz Stokes, Lisiane Pruinelli, George Demiris, Patricia Flatley Brennan; 2/26
Being a moral agent was once thought to be an irreplaceable, uniquely human role for nurses and other health care professionals who care for patients and their families during illness and hospitalization. Today, however, artificial intelligence systems are often referred to as “artificial moral agents,” “agentic,” and “autonomous agents.” As these systems begin to function in various capacities within health care organizations and to perform specialized duties, the question arises as to whether the next step will be to replace nurses and other health care professionals as moral agents. Focusing primarily on nurses, this essay explores the concept of moral agency, asking whether it remains exclusive to humans or can be conferred on AI systems. We argue that AI systems should not supplant nurses’ moral agency, as patients come to hospitals or any other health care setting to be heard, seen, and valued by skilled professionals, not to seek care from machines.
Editor's Note: Pair this with yesterday's article, ""Black box" artificial intelligence for mortality prediction: a mixed-methods study of palliative care team, patient, and caregiver perspectives."

Bridging the differences in care for grieving people: Worden's differentiation between grief counseling and grief therapy
Death Studies; by Mark D de St Aubin, William G Hoy; 2/26
Worden's (1982, 2018) landmark textbook on caring for bereaved individuals differentiated grief counseling from grief therapy, defining the former as the efforts of both professional and lay caregivers to support bereaved people in normal grief. Grief therapy, he posited, is the more structured intervention offered by credentialed caregivers to support individuals coping with a more complicated experience of mourning. In this article, the authors explain Worden's perspective, describe his types of complicated mourning for which grief therapy might be warranted, and offer clinical application to the approaches Worden takes.

Physicians are not providers: The ethical significance of names in health care: A policy paper from the American College of Physicians
Annals of Internal Medicine; by Lois Snyder Sulmasy, Jan K. Carney, for the ACP Ethics, Professionalism and Human Rights Committee; 2/26
More than 25 years ago, Pellegrino and Relman noted the increasing commercialization of the learned professions, anticipating what many physicians are increasingly experiencing today: an impairment of their ability to practice in accordance with standards of medical ethics and professionalism. These hurdles to the physician’s ability to do right by the patient contribute to what leaders in medicine and the American College of Physicians have called deprofessionalization. An example is the use of the term provider to describe physicians and other health professionals. The use of this terminology has been reviewed in medical journal articles but has not been adequately explored as a matter of ethics and professionalism. Through that lens, this paper examines the trends, significance, and implications for patients, physicians, and health care of the use of the term provider.

"I don't get to feel this good very often:" Virtual reality intervention for veterans receiving end-of-life care
Journal of Palliative Medicine; by Megan E Gately, Steven D Shirk, Anastasia Canell, Alexandra Laffer, Melanie Corle, Kristen Dillon; 2/26
We explored the use of VR [virtual reality] with patients receiving inpatient HPC [hospice and palliative care]. Twenty-five veterans with complex medical and psychiatric comorbidities at a Veterans Affairs hospital participated. Data related to self-reported pain and well-being, as well as session feedback, were gathered. Despite some challenges with setup, 91% reported enjoyment, and 90% would participate again. Travel experiences were most popular, allowing reminiscence and touring of bucket-list destinations. Program feedback suggested improvements in anxiety, mood, and boredom.

Burden and well-being among dementia caregivers in Puerto Rico: The role of behavioral and psychological symptoms of dementia
The Journals of Gerontology; by Junyub Lim, Ross Andel, Frank Puga, María P Aranda, Maricruz Rivera-Hernandez, Ana Luisa Dávila-Roman, Michael Crowe; 2/26
Dementia is more prevalent in Puerto Rico than in the U.S. mainland, increasing demands for caregiving. We examined caregiver burden and depressive symptoms among Puerto Rican dementia caregivers while also considering behavioral and psychological symptoms of dementia (BPSD). Caregivers were 63 ± 10 years of age on average, and 77% were women. In this Puerto Rico-based sample, perceptual disturbances/apathy, and appetite/eating symptoms specifically, were most likely to magnify the caregiver burden-depressive symptoms link.

A narrative review of attitudes and beliefs toward hospice and palliative care in South Asian Muslim communities
Journal of Palliative Medicine; by Adeela Mushtaq, Mona Tareen, Renato V Samala, Susan B LeGrand; 2/26
This article presents two case narratives illustrating reservations toward HPC [hospice and palliative care] in South Asian Muslim (SAM) communities, highlighting challenges and proposing strategies for culturally sensitive care. The first case demonstrates that, even with evidence-based and empathetic approaches, hesitancy toward HPC may persist. This underscores the need for (1) community-level initiatives leveraging religious and cultural platforms to educate and engage communities, and (2) greater awareness among healthcare professionals of these values to minimize conflict and reduce provider distress. In the second case, Islamic scholars were consulted regarding the use of sedative medicines at the end of life. They agreed such use is permissible under the principle of medical necessity, emphasized deference to medical expertise, and stressed preserving the patient's ability to recite the Shahadah (testimony of faith) in their final moments.

Religion and spirituality in pediatric end-of-life: A systematic review
Journal of Pediatric Psychology; by Kara Jackson, Alyssa Marchetta, Barry Nierenberg, Jessica M Valenzuela; 2/26
Spirituality is a recognized element of palliative care, with documented benefits for adult patients. However, limited research exists on how religion and spirituality affect children at end-of-life (EOL) and their parents. Findings revealed diverse religious and spiritual practices among families, including faith stability, spiritual care use, and prayer. Key outcomes associated with spirituality included enhanced coping, acceptance, meaning-making, hope, caregiver spiritual well-being, decision-making, and improved parent-child communication. Across studies, spiritual support emerged as a vital component of the pediatric EOL experience.

Corticosteroid use and risk of adverse events in metastatic hormone-sensitive prostate cancer
The Prostate; by Umang Swami, Qiujun Shao, Tamuno Alfred, Maelys Touya, Frank Cao, Pinal Kamdar, Jasmina Ivanova, Johanna Celli, David Nimke; 2/26
Among the approved therapies for metastatic hormone-sensitive prostate cancer (mHSPC), abiraterone and docetaxel are administered concomitantly with corticosteroids. This study evaluated the association between corticosteroid use and risk of adverse events among patients with mHSPC. Our findings suggest that patients exposed to corticosteroids are at increased risk of adverse events, hospitalization, and death. As not all mHSPC treatments require concomitant use of corticosteroids, these findings may help to inform treatment decision-making.

[Australia] The male approach to dementia caregiving: A scoping review
Australasian Journal on Ageing; by Vincent O Poisson, Amy E Peden, Roslyn G Poulos, Adrienne L Withall, Helen Jones, Kaele Stokes, Claire M C O'Connor; 3/26
The proportion of male caregivers of people living with dementia has been rising since the 1990s.  Four main themes were identified [in this review of the literature]: gender differences in caregiver burden; male caregivers adopt a task-focused approach to gain control over caregiving; sons step into the caregiver role as a last resort; and males have specific caregiver needs. The findings suggest that socially constructed masculinity norms influence how men approach dementia caregiving. The findings also suggest that sons caring for a parent with dementia have a different approach to caregiving compared with husbands.

How wonderful it is that nobody need wait a single moment before starting to improve the world. ~Anne Frank