Literature Review

CarePoint Health submits plans for layoffsModern Healthcare; by Hayley DeSilva; 9/18/24CarePoint Health submitted plans with New Jersey authorities to lay off more than 2,600 workers at three of its hospitals in the state. The layoffs would take effect Dec. 12, according to a Worker Adjustment and Retraining Notification notice filed with the state.

CVS' Oak Street Health pays $60M to settle kickback allegationsModern Healthcare; by Katherine Davis; 9/18/24Chicago-based healthcare firm Oak Street Health has agreed to pay $60 million to resolve allegations from the U.S. Department of Justice that it paid kickbacks to third-party insurance agents in exchange for recruiting seniors to Oak Street’s primary care clinics. The DOJ alleged in a statement today that Oak Street’s Client Awareness Program, designed to grow patient membership, had third-party insurance agents contacting seniors eligible for or enrolled in Medicare Advantage plans, seeking to recruit them to Oak Street locations.

New revised Medicaid Fraud Control Unit performance standardsOIG press release on X; 9/19/24HHS-OIG published revised Medicaid Fraud Control Unit (MFCU) performance standards. The standards provide helpful guidance to MFCUs in their operations and assist HHS-OIG in overseeing MFCUs. Read the performance standards here: https://direc.to/fj2o. 

Fraud losses among older adults reached $3.4 billion last yearMcKnight's Senior Living; by Kimberly Bonvissuto; 9/20/24The types of scams being reported to the federal government haven’t changed much from last year, but losses are on the rise, with the Federal Trade Commission reporting $10 billion in losses to consumers in 2023, $1 billion more than 2022 losses and the highest losses ever reported, according to a new fraud book. During a Thursday hearing on fighting fraud held by the Senate Special Committee on Aging, US Sen. Bob Casey (D-PA), committee chairman, released the group’s ninth annual fraud book, “Fighting Fraud: Scams to Watch Out For,” capturing the most common scams targeting older adults and resources to protect against fraud reported to various sources. FBI data show that fraud losses among older adults reached $3.4 billion in 2023, Casey said.

From pigs to payouts, weighing solutions for the US kidney shortageHealthcare Brew; by Caroline Catherman; 9/18/24About one out of every 20 people waiting for a kidney transplant die each year, according to the United Network for Organ Sharing. Scientists, policymakers, and other experts are scrambling to find a solution. Kidneys are currently the most needed organ in the country, and an ongoing crisis has left tens of thousands in limbo. As of September, nearly 90,000 people in the US are waiting for kidneys, but only around 27,000 transplants were performed in 2024, according to data from the Organ Procurement and Transplantation Network (OPTN).Publisher's note: Hospice Analytics, a Hospice & Palliative Care Today sponsor, posted this blog and has given presentations on opportunities and challenges for hospices to honor patient wishes regarding organ and tissue donation.

Mercy Health Home Care and Hospice by Compassus to provide care in Greater Lima Area HometownStations.com - ABC, FOX, NBC, CBS, Lima, OH; by Mercy Health - St. Rita's; 9/23/24 The Mercy Health Home Care and Hospice programs serving the greater Lima, Ohio, area, announced a new name today: Mercy Health Home Care and Hospice by Compassus. The name change reflects a joint venture partnership between Bon Secours Mercy Health, the fifth-largest Catholic health system in the U.S., and Compassus, a leading national provider of integrated home-based health care services, finalized earlier this year. Locations in Lima formerly managed by Mercy Health will be rebranded under the joint venture and managed by Compassus.

CMS revises instructions for AOs conducting initial certification surveysNAHC Report; 9/20/24... The revision clarifies initial certification processes for providers/suppliers seeking deemed status via a CMS-approved Accrediting Organization (AO). Specifically, for home health and hospice providers, the AO must not conduct an initial survey until the state agency has provided approval to the AO.Publisher's notes: 1) NAHC article may require member login; 2) CMS Admin Info: 24-22-ALL posted here.

New red flags emerge in hospice UPIC auditing Hospice News; by Holly Vossel; 9/20/24 Unified Program Integrity Contractor (UPIC) auditors are taking a sharper look at nursing home room-and-board for hospice patients. Hospices have increasingly faced more regulatory scrutiny in recent years amid rising program integrity concerns, including ramped up UPIC audits, among various others. These audits are designed to instill oversight measures aimed at safeguarding against bad actors in the hospice industry. Regulators have been zeroing in around hospices’ data when it comes to patient interviews and Medicaid skilled nursing room-and-board payments, among other aspects of care delivery. These data could give UPIC auditors clues as to potential malfeasance. However, auditors’ data extrapolation methodology is flawed and poses risks for quality hospice providers, according to Bryan Nowicki, partner at the law firm Husch Blackwell.

Wind phones help the bereaved deal with death, loss and grief − a clinical social worker explains the vital role of the old-fashioned rotary phone The Conversation; by Taryn Lindhorst; 9/20/24 My mother died in my home in hospice in 2020, on the day my state of Washington went into COVID-19 lockdown. Her body was taken away, but none of the usual touchstones for grief were available to our family. ... As a clinical social worker and health scholar with 40 years of experience in end-of-life care and bereavement, I knew that I needed some way to tend to my grief for my mother. While in lockdown, I began looking for resources to help me. Then I heard about the wind phone. What is a wind phone? At its simplest, a wind phone is a rotary or push-button phone located in a secluded spot in nature, usually within a booth-type structure and often next to a chair or bench. The phone line is disconnected. People use the wind phone to “call” and have a one-way conversation with deceased loved ones. Here they can say the things left unsaid. Wind phones offer a setting for the person to tell the story of their grief, to reminiscence and to continue to connect to the person who is gone. For many, it is a deeply moving, life-affirming experience. About 200 wind phones are scattered throughout the United States. Editor's note: This creative tool is similar to common clinical tools of writing a letter to the deceased person, and the "Empty Chair" technique. Caution: This should never be used as a gimmick. This can be terribly confusing and upsetting for persons with dementia, or supportive if used with professional sensitivity for the patient's awareness and experience. For persons with dementia, be familiar with the ground-breaking "Validation Therapy" techniques by Naomi Feil. 

Ascension posts $1.8B annual loss; liquidity 'remains strong,' CFO says Becker's Hospital CFO Report; by Alan Condon; 9/18/24 St.Louis-based Ascension reported a $79 million operating loss (-0.3% margin) for the 10 months ending April 30, a substantial improvement on the $1.2 billion operating loss in the previous 10-month period. The results include $402 million in one-time, non-cash write-downs and non-recurring losses. In May and June 2024, operations were hampered by the May ransomware attack, resulting in reduced revenues from the associated business interruption along with costs incurred to address the issues and other business-related expenses. Despite this incident, Ascension drove a $1.2 billion operational improvement year over year for the 10 months ending April 30. The 136-hospital system's economic improvement plans focused on volume growth, rates and pricing, and cost levers. 

Mirror, mirror 2024: A portrait of the failing U.S. health system - comparing performance in 10 nations The Commonwealth Fund; by David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, and Reginald D. Williams II Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement. Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.

Why CenterWell is moving into Walmart Becker's Payer Issues; by Rylee Wilson; 9/17/24 Primary care clinics focusing mainly on older adults are more likely to serve Black patients and those dually eligible for Medicare and Medicaid, a study from Humana found.  The study, published in Health Affairs in September, studied the outcomes of older adult-focused primary care organizations and found the organizations tend to enter and serve historically more disadvantaged communities. The authors defined such organizations as reimbursed predominantly through population-based payment arrangements and serving mostly older adults with Medicare. Humana's CenterWell is one such organization, alongside Oak Street Health and One Medical Seniors. CenterWell is expanding, with plans to enter three new markets in 2024. The company aims to add 30 to 50 new centers per year through 2025 and will also open clinics at 23 former Walmart Health sites.