Literature Review

Hospice CARE Act would create reimbursement for high-acuity hospice services Hospice News; by Holly Vossel; 8/19/24 If enacted, the Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act could open up reimbursement pathways for high-acuity palliative services during a time when demand and costs are rising. Developed by U.S. Rep. Earl Blumenaur (D-Oregon) and announced in June at the Hospice News Elevate conference, the bill proposed massive reimbursement and regulatory changes to the Medicare Hospice Benefit. Currently in a discussion draft phase, the bill includes ways for hospice providers to have clearer definitions and improved payment for more intensive forms of palliation, such as radiation therapy, blood transfusions or dialysis, among others.

New York State Department of Health Launches Center for Hospice and Palliative Care New York State Department of Health; Press Release; 8/19/24 The New York State Department of Health today announced the new Center for Hospice and Palliative Care, which will be under the Department's Office for Aging and Long Term Care (OALTC). The new Center, established under the leadership of Governor Kathy Hochul, will be led by Kara Travis, a health care executive who most recently served as Chief Executive Officer of Mountain Valley Hospice and Palliative Care in Gloversville, New York. "This new center will help us remove barriers that impact access to the profound comfort, support and dignity that palliative and hospice services can provide for individuals and families facing the end of life," State Health Commissioner Dr. James McDonald said. "Launching the Center for Hospice and Palliative Care was a top priority for this Department and highlights Governor Hochul's ongoing commitment to eliminating healthcare disparities for all New Yorkers."

Hospice physician’s convictions and $15 million in restitution affirmed for ‘pervasive’ fraud CCH Incorporated; by Justin Marcus Smith, J.D.; 8/15/24 The Fifth Circuit found it circumstantially telling that the jurors saw multiple hospice patients testifying at trial nearly a decade after the convicted physician had recommended them for end of life care. In an unpublished opinion, the United States Court of Appeals for the Fifth Circuit affirmed a physician’s conviction for conspiracy to commit health care fraud and for seven individual counts of healthcare fraud in connection with hospice care service recommendations. Applying de novo review, the court affirmed the convictions on the basis that the government presented enough circumstantial evidence, without direct evidence of intent, for a reasonable jury to have found guilt. With respect to sentencing, the circumstances surrounding 7,000 hospice claims formed a basis for fraud so pervasive that the government did not need to “sift” through each of the claims.

Wisconsin DHS to create an HCBS minimum fee schedule Open Minds, Gettysburg, PA; 8/15/24 The Wisconsin Department of Health Services (DHS) is developing a minimum fee schedule for a subset of Medicaid home- and community-based services (HCBS) for which no specific rates exist in fee-for-service Medicaid. The minimum fee schedule will apply to adult family homes, community-based residential facilities, residential apartment complexes, supportive home care (SHC) agencies, and self-directed SHC. The affected programs include Family Care, Family Care Partnership, and Program of All-Inclusive Care for the Elderly (PACE), which together serve nearly 57,000 older adults and adults with disabilities. 

Hospice’s post-VBID value-based outlook Hospice News; by Holly Vossel; 8/15/24 The post-Medicare Advantage hospice carve-in landscape could include wider value-based reimbursement avenues in the hospice space, leading providers to pivot into MA payer relationships. The forthcoming end of the hospice component of the value-based insurance design (VBID) demonstrative takes effect Dec. 31. Launched in 2021, the carve-in was designed to test coverage of hospice care through Medicare Advantage, as well as coverage of palliative and transitional care. Hospices will need a strong value-based payment negotiation strategy to prepare for the unknowns that lie ahead, according to Melinda Gaboury, co-owner and CEO of Healthcare Provider Solutions Inc., a hospice and home care consulting company. 

Humana will pay $90 million in Medicare drug fraud settlement Bloomberg Law; by Daniel Seiden; 8/16/24 Humana Inc. agreed to pay $90 million to the federal government to settle a whistleblower’s False Claims Act suit alleging that the company submitted fraudulent bids for Medicare Part D prescription drug contracts. Whistleblower Steven Scott alleged that, since 2011, Humana began offering its Medicare Part D prescription drug plan, known as the basic Walmart Plan, and “knowingly provided benefits under that plan that have been significantly less valuable than Humana promised in its bids,” according to Scott’s suit filed in 2016 in the US District Court for the Central District of California. ... This suit was among several in 2016, including suits against Humana, United Health, Cigna Corp., and Optum RX Inc., accusing health insurers of secretly overcharging for prescription drugs.

Medical marijuana study details Arkansans’ use of the drug, raises questions from lawmakers Arkansas Times; by Tess Vrbin for the Arkansas Advocate; 8/15/24 ... The study, conducted by the Arkansas Center for Health Improvement, is the first ever population-based study of medical marijuana funded by a federal health agency, the National Institutes of Health. ... The state currently has more than 105,000 cardholders, an increase of roughly 29,000 in three years, according to ACHI’s study. ... Lawmakers on the Joint Public Health, Welfare and Labor Committee ... expressed concerns about some of the information in the study, such as the fact that one-third of the certifications for medical marijuana cards in 2021 came from just seven doctors, with little evidence of a physician-patient relationship in many cases.Thirty-eight states and the District of Columbia have legalized marijuana to some extent, and Arkansas is one of 14 states in which the drug is legal only for medicinal purposes.

YoloCares: Overregulated California skips key regulations Our Community Now (OCN); by Craig Dresang, Special to The Enterprise; 8/17/24 California is the most heavily regulated state in the country. According to the Mercatus Center at George Mason University, the Golden State has 420,434 regulatory restrictions which is more than double the national average. ... So, it seems ironic that certain critically important sectors in California that impact the well-being, health and quality of life for millions of seniors are grossly unchecked and mis-regulated. My husband, who has owned and operated salons for nearly 30 years, pointed out that California’s Board of Barbering and Cosmetology (BBC) appears to have more rigorous rules and regulations for nail technicians than it does for board-and-care (B&C) owners or privately owned hospice companies. ... [Click on the title's link to continue reading.]

Why Optum thrives where other companies failed Becker's ASC Review; by Patsy Newitt; 8/16/24 UnitedHealth Group's Optum, parent company of Deerfield, Ill.-based ASC chain SCA Health, has seen massive growth in the last few years as other big healthcare networks face obstacles in reaching large-scale profitability. ... A key to Optum's success is its affiliation with a large insurance business. The Journal pointed to the "several financial incentives for an insurer to own a health provider, including that it pays itself." ... And Optum keeps growing. The company spent $31 billion on acquisitions in the last two years, The Oregonian reported May 13. ... UnitedHealth Group is facing scrutiny regarding the Change Healthcare ransomware attack in February. The attack delayed payment and claims processing for healthcare providers around the country, as UnitedHealth subsidiary Change Healthcare handles an estimated one in three healthcare transactions.

Bereaved parent preferences on quality end-of-life care for children with cancer in the South Cancer - American Cancer Society; by Isaac Martinez BA, Erin Currie PhD, RN, Elizabeth S. Davis MS, Rohail Kumar MD, Valerie Lawhon MS, ALC, NCC, Jennifer M. Snaman MD, Raba B. Tefera BA, Smita Bhatia MD, MPH, Abby R. Rosenberg MD, MS, MA, Emily E. Johnston MD, MS; 8/18/24 The authors sought to understand bereaved family preferences for end-of-life (EOL) care, particularly among Black families and those in the South. ... Family decision-making involved maintaining hope, not causing harm, doing what was best for their child and themselves, and religious beliefs. There was no clear preference for home versus hospital death (3.0 [1.8–4.0]). Instead, parents considered their child’s desires and/or medical needs, siblings, and prior experiences with death. To have a comfortable death, parents highlighted the need for comprehensive education about their child’s EOL, a caring and comfortable environment, and 24/7 access to their care team. Families expressed a dual preference for comfort care ... and chemotherapy ... at EOL.

Cognitive impairment in the workplace Alzheimer's Association; email 8/14/24, webpage posted 8/8/24 Due to the aging of the U.S. population, rates of cognitive impairment and dementia in the workplace are on the rise. This creates challenges for employers, many of whom may not know how to best support employees who are experiencing symptoms of cognitive impairment. Conversely, employees may be hesitant to share with their employer the challenges that they’re experiencing. ... Recommendations Regarding Dementia in the Workplace ... [Click on the title's link for this excellent HR information.]

Hospice funding crisis: an urgent message ehospice, UK Edition; by Helen Simmons, Chief Executive of St. Christopher's; 8/14/24 Growing numbers of people need hospice support – in the last year alone the number of home visits completed by our teams at St. Christopher’s increased by 10%. But many hospices – one in five – are either cutting specialist palliative and end of life services in the last year or plan to do so. Fortunately, we are not one of those at the moment. ... NHS funding has failed to keep up with the increase in demand and expenditure. We are increasingly relying on people leaving gifts in wills, running marathons and donating clothes to deliver our core services. The model is breaking. ... At St. Christopher’s we receive 34% of our income from the NHS – for the remaining 66% we rely on the generosity of the community. Hospices should not have to rely on the generosity of the community to provide essential healthcare services. ... Editor's Note: St. Christopher's is the first hospice of the modern hospice movement, pioneered by Dame Cicely Saunders in London, UK, in 1967.