Literature Review

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. 

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.

Financial pressures shut down 2 hospice agencies Hospice News; by Jim Parker; 9/20/24 A hospital-based hospice program in Kansas is closing its doors, as is the Visiting Nurses Association of Philadelphia. Holton Community Hospital (HCH) will shut down its home health and hospice department effective December 31st. A range of issues contributed to the decision to end the program, including reimbursement pressures on its home health business and the ascendance of Medicare Advantage, which often pays at a lower rate than traditional Medicare. The Holton, Kansas-based hospital also cited increased competition in its local community as a reason for the closure. ... The organization is working with other local providers to ensure continuity of care for its home health and hospice patients. Meanwhile in Pennsylvania, the Visiting Nurses Association of Philadelphia is also closing. The 138-year-old institution will cease operations on Oct. 28. It is a provider of hospice, home health and palliative care services.Editor's note: For more information about the VNA in Philadelphia, see the article we posted on 9/18/24, After 138 years, the Visiting Nurses Association of Greater Philadelphia will shut down all health care services next month.

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.

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. 

CVS' Oak Street Health to pay $60M to settle Medicare Advantage kickback allegations Becker's Health IT; by Naomi Diaz; 9/19/24 CVS subsidiary Oak Street Health has agreed to pay $60 million to settle accusations that it violated the False Claims Act by offering kickbacks to third-party insurance agents in return for referring older adults to its primary care clinics. ... The settlement addresses allegations that, between September 2020 and December 2022, Oak Street Health knowingly submitted false claims to Medicare by offering illegal payments to agents, violating the Anti-Kickback Statute. CVS acquired Oak Street Health for $10.6 billion in May 2023. 

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. 

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.

AI shouldn't decide who dies. It's neither human nor humane Fox News; by John Paul Kolcun and Anthony Digiorgio; 9/20/24 [Opinion] As we write this, PubMed ... indexes 4,018 publications with the keyword "ChatGPT." Indeed, researchers have been using AI and large-language models (LLMs) for everything from reading pathology slides to answering patient messages. However, a recent paper in the Journal of the American Medical Association suggests that AI can act as a surrogate in end-of-life discussions. This goes too far. The authors of the paper propose creating an AI "chatbot" to speak for an otherwise incapacitated patient. To quote, "Combining individual-level behavioral data—inputs such as social media posts, church attendance, donations, travel records, and historical health care decisions—AI could learn what is important to patients and predict what they might choose in a specific circumstance." Then, the AI could express in conversant language what that patient "would have wanted," to inform end-of-life decisions. We are both neurosurgeons who routinely have these end-of-life conversations with patients’ families, as we care for those with traumatic brain injuries, strokes and brain tumors. These gut-wrenching experiences are a common, challenging and rewarding part of our job. Our experience teaches us how to connect and bond with families as we guide them through a life-changing ordeal. In some cases, we shed tears together as they navigate their emotional journey and determine what their loved one would tell us to do if they could speak. 

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.

New data explores trust gap between execs and employees HR Daily Advisor; by Lin Grensing-Pophal; 9/19/24Creating a harmonious workplace where trust flourishes between employers and employees is crucial for aligning incentives and driving employee engagement. Unfortunately, that trust is often hard to find in the business world. ... Consider, for example, these data points from the PwC survey: