Literature Review

NABIP responds to HHS Proposed Rule on Marketplace Integrity National Association of Benefits and Insurance Professionals; by Kelly Lousedes; 4/14/25 The National Association of Benefits and Insurance Professionals (NABIP) submitted formal comments to the Department of Health and Human Services (HHS) on the Centers for Medicare & Medicaid Services’ (CMS) proposed rule, CMS-9884-P: Marketplace Integrity and Affordability. While NABIP strongly supports efforts to enhance program integrity, it strongly objects to elements that could lead to unfair treatment of licensed health insurance professionals. ...

CMS halts spending for nonmedical in-home Medicaid services, likely affecting providers McKnights Home Care; by Adam Healy; 4/13/25 The Centers for Medicare & Medicaid Services told states last week that it would not approve future federal matching funds for designated state health programs (DSHPs) and designated state investment programs (DSIPs). These programs are widely used to help Medicaid beneficiaries remain at home and in their communities.

The modern health care professional: How to combine skills from different fields to redefine your career MedPage Today's KevinMD.com; by Jalene Jacob, MD, MBA; 4/11/25 Gone are the days when careers followed linear paths and job titles neatly fit into predefined boxes. Today’s health care industry celebrates versatility, and hybrid professionals are redefining what it means to succeed. A hybrid health care professional combines skills and expertise from different fields, blending knowledge to create unique value in the health care space. Whether you’re a nurse with coding skills, a doctor with a passion for data analysis and research, or a biomedical engineer with a talent for design and business, hybridization is becoming the new competitive advantage. This article explores how early professionals can harness their diverse interests and talents to shape their careers and stand out in a rapidly evolving job market.

CMS clarifies physician referral authority, tightens attestation requirements in proposed hospice ruleInside Health Policy; by Jalen Brown; 4/11/25... The proposed rule would explicitly allow the physician member of the hospice interdisciplinary group (IDG) to recommend patients for hospice care, addressing a gap in current regulations over which physicians have that authority. While CMS already lets IDG physicians certify that a patient is terminally ill and eligible for hospice, the existing admission rules only name the hospice medical director or physician designee as authorized to recommend admission. CMS also wants to strengthen documentation requirements for hospice recertification, ... Starting at day 180 and every 60 days thereafter, Medicare requires a hospice physician or nurse practitioner (NP) to conduct a face-to-face visit with the patient before recertifying eligibility. After the visit, the clinician must provide a written attestation confirming that the visit occurred and was used to assess whether the patient still qualifies for hospice care. Under CMS' proposal, that attestation would also need to include the clinician's signature and the date signed, submitted as a clearly labeled section or addendum to the recertification form. 

Attorney General Platkin co-leads multistate effort to protect Affordable Care Act from attack State of New Jersey - Department of Law & Public Safety, Trenton, NJ; Press Release by the Office of the Attorney General, Matthew J. Platkin; 4/14/25  Attorney General Matthew J. Platkin, along with the Attorneys General of California and Massachusetts, co-led a multistate letter regarding a raft of proposed changes that would undermine the Affordable Care Act (ACA), making it more difficult and expensive for individuals to enroll in health coverage on federal and state exchanges. The U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make a number of regulatory changes impacting access to insurance via the ACA. If allowed to take effect, the proposed changes would reduce access to ACA exchanges and risk causing between 750,000 and two million Americans to lose health insurance coverage in 2026. That would impose harms on States and their residents, both insured and uninsured, as when more individuals are forced to go without insurance, costs are driven up for everyone.

For AYAs with advanced cancer, study finds serious communication gaps about their care National Cancer Institute; by Daryl McGrath; 4/15/25 Many adolescents and young adults (AYAs) with advanced cancer don’t have discussions with their clinicians about how they want to approach palliative care until the final weeks of life, a study of medical records of nearly 2,000 young patients showed. ... Talking about care and treatment near the end of life is one of the most challenging aspects of caring for AYAs with advanced cancer, said Ashley Wilder Smith, Ph.D., M.P.H., of NCI’s Healthcare Delivery Research Program and co-leader of NCI’s Adolescent and Young Adult Oncology Working Group. ... “When a young person is faced with a disease that may lead to an early death, it’s vitally important to give them the opportunity to think about what’s most important to them and what happens to them in terms of care in the time they have left,” she said.

Hospitalists in a bind when cancer prognosis hasn’t sunk inMedscape; by Jake Remaly; 4/15/25 When a patient with cancer is admitted to the hospital, the reason might not be related to the malignancy. But the hospitalist in charge sometimes becomes aware of a major disconnect: The patient, who they just met, does not grasp the severity of their cancer prognosis. On the one hand, the hospital medicine team and patient have advance directives and goals of care to consider, which may steer the course of the hospitalization and any use of hospice. The cancer prognosis — the patient might only have months to live, for example — could be a key component of those conversations. On the other hand, explaining the cancer situation should fall to the oncologist, right? ...

Health systems spend millions to reduce workplace violence Modern Healthcare; by Caroline Hudson; 4/14/25 Health systems are spending millions of dollars ramping up security measures at their facilities to protect patients and staff. Many systems are hiring more officers, implementing weapons detection screenings and updating communication protocols. Executives said these efforts are a response to an uptick in workplace violence over the past several years, ranging from assaults on staff members to sexually aggressive comments and shootings. ... [A] 2022 report from the Online Journal of Issues in Nursing said workplace violence costs the U.S. approximately $151 billion per year, with most incidents occurring in healthcare and social services.

Why AI demands a new breed of leadersMIT Sloan Management Review; by Faisal Hoque, Thomas H. Davenport, Erik Nelson; 4/9/25Artificial intelligence is changing how humans and machines work together. But most organizations still focus on the technical aspect of AI implementation because their leadership structure does too. Companies need a new role, the chief innovation and transformation officer, to manage the profound cultural and organizational changes AI adoption brings. Here’s why forward-thinking organizations already have or plan to hire such leaders.

Closing the gap in end-of life care coverage: The role of nonprofits in policy advocacy Forbes; by James Dismond; 4/14/25... As the demand for end-of-life care grows, so will the gap between the care that patients need and what they receive. ... Workforce shortages, restrictive regulations, outdated reimbursement models and misconceptions around hospice services are keeping millions of Americans from accessing quality hospice and palliative care services. ... These barriers disproportionately affect low-income families, rural communities and communities of color. ... Unlike for-profit entities, we can prioritize community needs over shareholders. We can prioritize patient well-being over profits—or, to say it more directly, we put people over profits. And I’ve seen firsthand how advocacy can drive progress. Nonprofits must engage in:

CMS Refocuses on its Core Mission and Preserving the State-Federal Medicaid PartnershipCMS press release; 4/11/25The Centers for Medicare & Medicaid Services (CMS) is taking action to preserve the core mission of the Medicaid program by putting an end to spending that duplicates resources available through other federal and state programs or isn’t directly tied to healthcare services. Mounting expenditures, such as covering housekeeping for individuals who are not eligible for Medicaid or high-speed internet for rural healthcare providers, distracts from the core mission of Medicaid, and in some instances, serves as an overly-creative financing mechanism to skirt state budget responsibilities.

ECHO Health gifts $5 million to Quality of Life Campaign; Center for Community Engagement to be name Hospice of the Western Reserve, Cleveland, OH; Press Release; 4/10/25 Hospice of the Western Reserve has received a historic $5 million gift to its Quality of Life capital campaign from ECHO Health, the Westlake-based company founded by the late Bill Davis. This transformative contribution, the largest single gift in the organization’s history, will accelerate the completion of its new Hospice Care & Community Center on Cleveland’s Lake Erie shore. ... In recognition of this gift, the facility’s Center for Community Engagement will be named in honor of Bill Davis. 

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