Literature Review

SCAN wins Medicare Advantage star ratings lawsuit against CMSModern Healthcare; by Nona Tepper; 6/4/24SCAN Health Plan has prevailed in a widely watched federal lawsuit brought last year against the Centers for Medicare and Medicaid Services that alleged regulators did not appropriately calculate the insurer's Medicare Advantage star rating. The decision could have industrywide implications for the star ratings program if regulators decide to recalculate all carriers’ star scores for the 2024 plan year. The ruling could also affect several pending cases filed by other insurers against CMS. It also could be appealed.

Oregon reviews UnitedHealth deal for Amedisys home health, hospice The Lund Report; by Nick Budnick; 6/4/24State officials are asking members of the public to weigh on the proposed acquisition of Amedisys — a hospice and home health and company that operates in Roseburg, Salem and Portland — by an increasingly controversial health care giant called UnitedHealth Group. Inc.  UnitedHealth operates Optum, a subsidiary whose takeover of a clinic chain in the Eugene area has sparked numerous complaints. The state recently approved the company's acquisition of  The Corvallis Clinic, an 11-clinic company operating in three counties. Now, it proposes to take over the Oregon offices of a Amedisys, a publicly traded firm, and the transaction has federal officials contemplating a lawsuit to block it. UnitedHealth and Optum are under increasing scrutiny for their market dominance and allegations of anticompetitive conduct.

Saint Therese to transition its New Hope Senior Community to new ownership Big Country Homepage; by Accesswire; 6/4/24 After years of intensive research and deliberation about the future of its New Hope senior living community, aging services provider Saint Therese today announced it is transitioning Saint Therese of New Hope [Minn.] to new ownership, supported by senior care provider Compass Healthcare. The transition is expected to be final on August 1, 2024 and the name will change to Woodlake Care Center and Woodlake Residences. ... Abbott said the Saint Therese organization remains dedicated to the senior care and services industry, has no future plans to transition any of its other communities and remains focused on expanding the mission and ministry in the communities in which we are blessed to serve. Saint Therese currently has three locations in the Twin Cities metro, in Brooklyn Park, Woodbury, a new community opening in the fall in Corcoran, a hospice and palliative care home in Shoreview and a community in Monroe, Mich. 

Normandy Welcomes World War II Heroes - 80th AnniversaryU.S. Department of Defense; 6/4/24World War II veterans met with cheers and applause from throngs of well-wishers as they arrived in Normandy, France, for events commemorating the 80th anniversary of D-Day. ... The number of these heroes at D-Day anniversary events in Normandy each year is diminishing, but the gratitude and awe for their service and sacrifice endures.We Honor Veterans - NHPCONHPCO; retrieved from the internet on 6/5/24We Honor Veterans empowers end-of-life care partners to meet the unique needs of America’s Veterans and their families. Our guidance and resources are focused on respectful inquiry, compassionate listening and grateful acknowledgment so that veterans can be guided through their life stories toward a more peaceful ending.Editor's Note: Thank you NHPCO for your foresight in developing this program! You identified the massive losses of our WWII generation of veterans (and more). You educated hospice organizations nation-wide and equipped us with meaningful resources, while we still had years of time to provide active support.

LeadingAge: CMS on right track with high-acuity hospice RFIHospice News; by Jim Parker; 5/31/24 The senior care advocacy group LeadingAge has praised the U.S. Centers for Medicare & Medicaid Services (CMS) inquiries into high-acuity palliative care, but expressed concern over reimbursement and staffing issues. The agency’s 2025 proposed hospice rule featured a series of requests for information (RFI) on issues like health equity, social determinants of health and future quality measures. The RFIs contain further questions about the utilization of higher-cost palliative treatments under the Medicare Hospice Benefit. The agency posed similar queries in its proposed rule for 2024. The new proposal seeks greater clarity on the financial risks and costs that providers say represent barriers to providing those services, such as palliative chemotherapy, radiation blood transfusions or dialysis, among others.

What health system CEOs need to tackle conflict, change Becker's Hospital Review; by Laura Dyrda; 5/31/24  Health system CEOs are leaving behind ego-driven, top down leadership in favor of a trusting and a supportive culture to guide their organizations and transform healthcare delivery. Change is hard, but necessary, to grow. "One of my greatest realizations is the importance of fostering a culture where every individual genuinely feels valued and supported," K. Craig Kent, MD, CEO of Charlottesville, VA.-based UVA Health and executive vice president of health affairs at the University of Virginia told Becker's. ... Change is happening on many fronts. More care is exiting the hospital to be delivered at outpatient sites, in the home and through virtual connections. Patients are more actively participating in decision-making about their care, and digital technology makes it possible to personalize care more than ever before. ...

Palliative care significantly improves discussion and documentation of end-of-life care preferences among patients with AML and MDS Oncology Learning Network; transcribed interview featuring Areej El-Jawahri, MD; 6/1/24 Areej El-Jawahri, MD, Massachusetts General Hospital, Boston, Massachusetts, discusses results from a clinical trial comparing a collaborative palliative and oncology care model vs usual care for adult patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). The study showed that palliative care significantly improved the rates of discussion and documentation of end-of-life (EOL) care preferences, reduced hospitalization at the EOL, and improved the quality of life in patients. 

National aging framework outlines governmentwide initiatives promoting home-based careMcKnight's Home Care; by Adam Healy; 6/3/24The Department of Health and Human Services released a new framework for its National Plan on Aging on Thursday. The framework aims to guide a multifaceted, governmentwide approach to help caregivers and home- and community-based service providers enable older adults to age comfortably in place.

Joel Mekler - Medicare Moments: Watch out for these latest scams New Castle News; by Joel Mekler; 6/3/24 ... Across the country, many unscrupulous hospice providers are recruiting and enrolling nonterminally ill patients for end-of-life care they do not need and then billing Medicare for services and items they may never receive. They trick beneficiaries into signing up for hospice by offering freebies, such as additional groceries, nurse visits, durable medical equipment, bus coupons, and more once they enroll. They also make false claims, such as saying “Medicare now covers cooking and cleaning services”. Or they tell beneficiaries they qualify due to age, saying “You’re now old enough to qualify for hospice!” Another tactic is giving money, with some recruiters telling beneficiaries, “You can earn $400/month if you agree to enroll in our program.” ... Tips [to consumers] to avoid hospice fraud:

Community Hospice & Palliative Care setting sights on Florida, Georgia expansionHospice News; by Holly Vossel; 6/3/24Florida-based Community Hospice & Palliative Care recently opened a new location in its home state that will serve as an office for interdisciplinary staff and a community center. The new center is a key part of the hospice and palliative care provider’s overall strategic growth plans to improve access among underserved populations, according to Community CEO Phillip Ward. ... One aim of launching the center is to improve care collaboration and access among African Americans in the community, according to Ward.

Hawaiʻi is the first state to provide palliative care coverage EIN Presswire; by Governor JOsh Green, MD; 4/4/24 Governor Josh Green, M.D., and the Department of Human Services (DHS) Med-QUEST Division are pleased to announce that the Centers for Medicare and Medicaid Services (CMS) approved a new State Plan Amendment (SPA) to cover community palliative care services through Medicaid, making Hawaiʻi the first state in the nation to do so.  ... “After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” said Governor Green. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.”  

5 things to know about the sorry state of healthcare cybersecurityMedCity News; by Katie Adams; 5/22/24Nitin Natarajan, deputy director at the Cybersecurity and Infrastructure Security Agency (CISA), shared some key ideas that people need to understand about the current state of cybersecurity in the healthcare industry.