Literature Review

Medicare Advantage plan spending and payments under the hospice carve-outJAMA Network Open; by Meghan Bellerose, Andrew M Ryan, Claire K Ankuda, David J Meyers; 8/25In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction ... Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments. In this cross-sectional study, MA plans received high premium and rebate payments for beneficiaries enrolled in hospice despite low health care spending after enrollees elected hospice. To reduce excess payments, the Centers for Medicare & Medicaid Services could require MA plans to submit information on enrollees' use of supplemental benefits and adjust payments made after election of hospice to align with spending.

Improving community-based palliative care explanations: Insights from persons declining servicesAmerican Journal of Hospice & Palliative Care; by Kira G Sheldon, Kathryn H Bowles, Elizabeth A Luth; 8/25Beneficiaries and caregivers had mixed understandings of palliative care, including: no knowledge, belief that it was the same as or pre-hospice, and accurate, but often one-dimensional understandings of it. Participants recommended providing individualized, tailored explanations focused on the person's health concerns in simple language with follow-up materials to improve engagement with palliative care. Small adjustments to how palliative care is explained may increase understanding among older adults and caregivers, particularly among those with limited or inaccurate knowledge. Among those familiar with palliative care, providing accessible and clear explanations customized to the person's specific care needs can further broaden understanding and increase perceived relevance.

Implementing education for community adult hospice nurses to expand pediatric hospice and palliative careJournal of Hospice and Palliative Nursing; by Shelly C Wenzel; 8/25Pediatric hospice and palliative patients require specially-trained clinicians to provide holistic support in areas such as disease progression, illness trajectory, and goals of care. An asynchronous online educational module, including a pre- and postmodule survey, was developed to provide education on timely pediatric quality-of-life conversations and skills for nurses who work with the adult population. Following the education module, participants reported an increase in comfort from 25% to 93.3% and willingness from 59% to 93.3%. Additionally, postmodule confidence level increased to 94%. These findings suggest an asynchronous educational module approach benefits the needs of community-based adult hospice and palliative nurses and gains learned from this module may enhance nurse skill and improve access to care.

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.

[Australia] The unmet needs of parents in pediatric palliative care: A qualitative systematic reviewJournal of Palliative Medicine; by Piyumi Senanayake, John Oldroyd; 8/25The goal of pediatric palliative care is to improve the quality of life of children with life-limiting or life-threatening disease and their families through a holistic care approach. Thirteen studies were included [in this analysis]. Five major themes emerged: (1) pediatric palliative care services delivery and care coordination, (2) emotional, psychological, and spiritual support, (3) end-of-life care and bereavement support, (4) practical and daily living support, and (5) communication and information. Parents reported unmet needs in multiple dimensions and wished for more support in caring for their children. Given that all of the unmet needs align with already established pediatric palliative care standards, this review highlights the need for revised health care policies and practices that will lead to better implementation of these standards in practice.

Benefits and burdens of research participation: A mixed methods systematic review in palliative and end-of-life careJournal of Hospice and Palliative Nursing; by Cara L Wallace, Stephanie P Wladkowski, Ruaa Al-Juboori, Anna Wingo, Kathryn W Coccia, Rebecca Hyde, Verna Hendricks-Ferguson; 8/25Research participation of hospice and palliative care patients and family caregivers is essential to develop and test best practices. Yet, healthcare professionals are often hesitant to ask patients and caregivers to participate in research, fearing it is too intrusive or unethical during a sensitive time. This review focused on the motivating factors, benefits, and burdens of research participation for patients with serious illness and their family caregivers. For clinicians and researchers, connecting patients and caregivers to palliative and end-of-life research may be both beneficial as a contribution to scientific literature and as an additional source of ongoing support.

[Canada] How mobile palliative care unit is making a difference Ontario Hospital Association - New Models of Care, Ontario, Canada; Press Release; 9/9/25 Launched earlier this year, the PEGASUS program, short for palliative expertise group for ambulatory support and unified solutions, is an innovative, mobile model of care that brings palliative medicine directly to patients in outpatient clinics across the hospital. Rather than establishing a traditional clinic space, the PEGASUS team “flies” to where the need is. ... The result: a consultation-based team that integrates seamlessly into existing ambulatory clinics, avoiding duplication of services and focusing on enhancing continuity of care. 

Family says bear attack victim to be transferred to hospice care KNWA/KFTA FOX-24, Little Rock, AR; by Justin Trobaugh; 9/9/25 The family of a Franklin County man says Sept. 8 that his condition has worsened and that he has been moved to hospice care. Vernon Patton, 72, is being held at the University of Arkansas for Medical Sciences after being attacked by a bear in the Mulberry Mountain area of Franklin County on Sept. 3. Patton was working on a gravel road with his tractor near Mulberry Mountain Lodge Park when the black bear attacked, according to Keith Stephens with the Arkansas Game and Fish Commission (AGFC). His son arrived to check on him and saw the bear actively attacking. Editor's Note: Executive leaders, traumatic events like this that lead to a hospice admission call for extra support for your clinical, direct care professionals and volunteers. They can experience secondary trauma as they tend horrific wounds, both physical (for the patient) and emotional (for family and friends). Also, what policies do you have in place to balance important community news and family privacy (e.g. staff or volunteers posting anything on social media).

Executive Personnel Changes - 9/12/25

What I learned about dying while caring for my husbandBK Books; by Barbara Karnes; 9/3/25It is hard to comprehend that our special person will die no matter what we do. No matter how many treatments, how much medicine, or how much food we give, death will come. We often don’t see what we don’t want to see. When it comes to acknowledging the end of life’s approach, this sentence is very true. My husband recently died of cancer. I am an end of life educator. I know what dying looks like, how it progresses, and what to do to support the person on their journey. Here are some insights that have been added to my knowledge as the result of walking in caregiver shoes...Publisher's note: Having a family member die earlier this year, and building on Barbara's theme, I ask hospice providers "does the hospice care your loved one received match the quality of hospice care you deliver?"

Choices Healthcare names new president and CEO, Michael Link TownLively.com, Lancaster, PA; Press Release; 9/9/25 Choices Healthcare has announced the appointment of Michael Link as its next president and chief executive officer, effective Wednesday, Oct. 1. The decision follows a national search and reflects unanimous support from the board of directors. Choices Healthcare is the parent organization of Hospice & Community Care and Hospice of Central PA. Link has been with the organization for more than two decades. He joined Choices Healthcare, then known as Hospice of Lancaster County, in 2001 as an information systems trainer. Over the years, he advanced through roles including director of information technology, vice president and chief information officer, chief administrative officer and, most recently, chief operating officer. ... Steve Knaub, the current Choices Healthcare president and CEO, will serve as special adviser to the board through his retirement on Wednesday, Dec. 31.

COUNTDOWN: 18 Days Until HOPE Tool Starts, October 1, 2025