Literature Review

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.” ...

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: ...

Palliative care nursing: Podcast with Betty Ferrell about ELNECGeriPal Podcast; by Alex Smith, Eric Widera, and Betty Ferrell; 4/26/24As Betty Ferrell says on our podcast today, nurses play an essential role in care of people with serious illness. Who spends the most time with the patient in the infusion center? Doing home care? Hospice visits? In the ICU at the bedside? Nurses. ELNEC (End-of-Life Nursing Education Consortium) celebrates it’s 25th anniversary in 2025. We talk today with Betty Ferrell, who has been a nurse for 47 years, and is the founder and PI of ELNEC.

Palliative care’s value-based future Hospice News; by Jim Parker; 4/24/24 Many believe that the fee-for-service model does not sufficiently support a robust palliative care program, meaning that providers must turn to value-based systems for sustainable reimbursement. But primarily, Medicare still reimburses for palliative care through fee-for-service payment programs that cover physician and licensed independent practitioner services. That model does not sufficiently cover the full range of interdisciplinary care, Dr. Julia Friedman, palliative care medical director at Thyme Care, said at the Home Health Care News Cap+Strat Conference.

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. 

Remote access technologies expose home care firms to cybersecurity vulnerabilities, experts sayMcKnights Home Care; by Adam Healy; 4/18/24 Some of the most commonly used technologies in home care are also among the easiest for criminals to exploit. ... Remote access systems include any technology that allows users to connect to and access a computer, server or network remotely. Within home care, this could be tools such as remote patient monitoring devices, secure messaging apps, telehealth platforms, cloud-based applications or systems that allow users to remotely access patient data, according to the Department of Health and Human Services. And while these technologies bring efficiency, they can also expose providers and their patients to risk.

Extra: CMS publishes rule outlining final staffing requirements McKnights Long-Term Care News; by Kimberly Marselas; 4/22/24 The Centers for Medicare & Medicaid Services said it would exempt nursing homes from having registered nurse coverage for up to 8 out of 24 hours a day “under certain circumstances,” unveiling a critical new detail in the second part of today’s staffing rule rollout. A director of nursing also can count toward the rule’s 24/7 RN requirement, CMS said, noting a change that providers will likely appreciate given their persistent challenges hiring RNs across the country. “The RN onsite 24 hours a day, seven days a week requirement ensures that there is an RN available to help mitigate, and ultimately reduce, the likelihood of preventable safety events, particularly during evenings, nights, weekends, and holidays,” CMS said. ...

People who have come to know the joy of God do not deny the darkness, but they choose not to live in it. They claim that the light that shines in the darkness can be trusted more than the darkness itself and that a little bit of light can dispel a lot of darkness. They point each other to flashes of light here and there, and remind each other that they reveal the hidden but real presence of God. ~Henri Nouwen, The Return of the Prodigal Son.

A life spent making mistakes is not only more honorable, but more useful than a life spent doing nothing. ~George Bernard Shaw

End-of-life and palliative care for lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity older adultsClinics in Geriatric Medicine; by Evie Kalmar MD, MS, Jeffrey Mariano MD; 5/24Lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) people are more likely to have alternative family structures. It is important to engage in advance care planning to understand their values, clarify surrogate decision makers, and contribute to goal-concordant care at the end of life. Clinicians can follow recommendations in this article to ensure they are providing LGBTQ-inclusive palliative and hospice care.