Literature Review

California hospital to lay off 191 workers as it faces loss of Medicare contract Becker's Hospital CFO Report; by Kelly Gooch; 4/24/24 Stanislaus Surgical Hospital in Modesto, Calif., which is facing a decision from CMS to end its Medicare contract, is laying off 191 employees, according to regulatory documents filed with the state April 15. The layoffs are effective April 30, the same day CMS said it will terminate the Medicare Provider Agreement with the hospital. In a notice dated April 11, the agency said it is terminating the agreement because of the hospital's noncompliance with the Medicare conditions of participation. 

Life is like riding a bicycle: to keep your balance you must keep moving. - Albert Einstein

Getting your claims denied? Here are reasons why and what you can do about itMedial Economics; by Gretchen Heinen, RN, PHN, BSN and Wael Khouli, MD, MBA; 4/25/24A recent voluntary, national survey by Premier shed new light on denied claims. The survey, conducted from October to December 2023, revealed that nearly 15% of all claims across Medicare Advantage, Medicaid, Commercial, and Managed Medicaid are denied. Of those denied claims, 45% to 60% were overturned, albeit with a costly appeal process sometimes involving multiple appeals. ... With a skillfully crafted appeal letter, a denial can be overturned 50% to 70% of the time. In this article, we will cover denial basics, reasons for claim denials, and actions to take. It is crucial to address all potential reasons for claim denial, including: ...

Novant Health launches 'hospital at home' with $2.7M donation Becker's Health IT; by Giles Bruce; 4/24/24 Winston-Salem, N.C.-based Novant Health launched a hospital-at-home program thanks to a $2.7 million donation. The health system rolled out the program in March at its coastal North Carolina region, and said the ideal patient is one likely to need four days or fewer of inpatient care. ... atients, who are monitored by technology around the clock, have 24/7 access to a remotely located registered nurse, receive at least two visits a day from paramedics, and meet virtually with a physician once daily. ... The New Hanover Regional Medical Center Foundation provided $2.7 million to help with operational startup costs. Novant Health received a waiver from CMS for the program in 2021.

Relief provisions not enough to mitigate damage of 80/20 policy, providers say McKnights Home Care; by Adam Healy; 4/24/24 Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate. “Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,”  the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published. 

CC Biz Buzz: Death, taxes and planning Columbia Daily Tribune; by Mary Dorn; 4/24/24 This column is one that I never really wanted to write, but, in hindsight, it is likely one of the most important that I will write. Monday, April 15, 2024, the dreadful “tax day” was upon me, and I was at a local funeral parlor making the final arrangements for my spouse and partner of 23 years. I kept thinking of the famous quote by Benjamin Franklin, “In this world, nothing can be said to be certain except death and taxes.” ...

Generative AI is supposed to save doctors from burnout. New data show it needs more trainingSTAT+; by Casey Ross; 4/25/24After stratospheric levels of hype, early evidence may be bringing generative artificial intelligence down to Earth. A series of recent research papers by academic hospitals has revealed significant limitations of large language models (LLMs) in medical settings, undercutting common industry talking points that they will save time and money, and soon liberate clinicians from the drudgery of documentation.

Across the nation, the fight’s on to protect physician-led careAmerican Medical Association - AMA; by Kevin B. O'Reilly; 4/25/24After helping state medical associations and national specialty societies defeat more than 100 bills to inappropriately expand nonphysicians’ scope of practice in 2023, the AMA is again relentlessly joining its allies in organized medicine to continue the fight for physician-led, team-based care in this year’s legislative session. This intensive and effective advocacy effort has ranged across the country, as the AMA has helped battle scope creep in Alaska, Connecticut, Georgia, Oklahoma, New Hampshire and elsewhere.

The Dos and Don’ts of enhanced service contractsSpecialty Pharmacy Continuum; by Marcus A. Banks; 4/25/24 ... Any pharmacy that interacts with patients—an independent pharmacy, an ambulatory infusion clinic, a health system or specialty pharmacy—can enter an enhanced service contract with a pharmaceutical company. All services offered under these contracts should be documented, auditable and offered at fair prices. Before approaching the company about partnering, Mr. Suchanek advised understanding the distinction between basic and enhanced services. ... “Pharmacy leaders need to demonstrate that they are credible partners,” [David] Suchanek said [Executive Vice President for  Biotech & Specialty Services at D2 Solutions].

Home care industry slams finalized 80-20 Rule, warns agency closures are coming Home Health Care News; by Andrew Donlan; 4/22/24 The “Ensuring Access to Medicaid Services” rule has been finalized. Most importantly, the bemoaned “80-20” provision has gone through as proposed, meaning providers will eventually be forced to direct 80% of reimbursement for home- and community-based services (HCBS) to caregiver wages. ... Organizations like the National Association for Home Care & Hospice (NAHC) and LeadingAge immediately condemned the rule being finalized on Monday. ...

Hospice boss warns of funding challenges BBC News; Josh Sandiford; 4/28/24[United Kingdom] A West Midlands hospice boss has warned it faces a "huge challenge" under the current funding model. Acorns Children's Hospice, which is based in Birmingham, told the BBC the situation was not sustainable despite demand for its services growing. It came after Hospice UK said there was a £77m funding deficit at centres across the UK. Editor's Note: We highlighted this recurring theme from the United Kingdom in posts on 4/16/24 and 4/17/24 in our "International" section. Pairing this critical, ongoing financial crisis with our article on 4/19/24, "Will Assisted Dying in Europe Impact Living With Dignity?", how might these potential losses of effective hospice care impact patients' desires for assisted dying? What similar trends are we seeing in the United States?

States lack resources to support new Medicaid waiver programs, association asserts McKnights Home Care; by Adam Healy; 4/22/24Medicaid 1115 waivers, which are commonly used to improve or expand home- and community-based services, face serious challenges as understaffed state programs are increasingly incapable of moving proposals through the administrative “pipeline,” the National Association of Medicaid Directors said in a recent letter. “The tough reality is that the Center for Medicaid and CHIP Services, which has taken many steps to streamline its administrative processes, simply does not have the staff resources to move forward all of the waivers in its pipeline,” Kate McEvoy, executive director of NAMD, wrote in the letter.