Literature Review

Doctor sues to save Medicare billing rights over hospice role Bloomberg Law; by Ganny Belloni; 10/24/24 A medical director designee at a California hospice sued the US Department of Health and Human Services to prevent the termination of his physician billing privileges after an independent contractor found his affiliation with the facility posed a fraud risk to the Medicare program. The lawsuit filed Wednesday by internal medicine physician Rami Shaarawy seeks injunctive relief from the US District Court for the Central District of California preventing the HHS’ Centers for Medicare & Medicaid Services from sanctioning the doctor until his dispute is resolved through Medicare’s internal appeals process.

Bill introduced to increase access to advanced wheelchairs HomeCare, Nashville, TN; 10/24/24 U.S. Senators Marsha Blackburn (R-Tenn) and Tammy Duckworth (D-Ill.) introduced the Choices for Increased Mobility Act (S 5154) to increase access to wheelchairs made with advanced materials by allowing Medicare beneficiaries to upgrade to lighter, more functional wheelchairs without bearing the entire upfront cost. These manual wheelchairs help prevent shoulder injuries, enhance maneuverability and reduce overall pain and fatigue for users. ... When the Medicare billing code for ultra-lightweight manual wheelchairs was established in 1993, materials like titanium and carbon fiber were not considered, as they were not yet in use for wheelchairs. As a result, ... providers have struggled to supply wheelchairs with these advanced materials at the fee schedule amounts set by Medicare.

Study: Hospice care provides major Medicare savings Medical Xpress; by Peter Dizikes, Massachusetts Institute of Technology; 10/24/24 Hospice care aims to provide a health care alternative for people nearing the end of life, by sparing them unwanted medical procedures and focusing on the patient's comfort. A new study co-authored by MIT scholars shows hospice also has a clear fiscal benefit: It generates substantial savings for the U.S. Medicare system. ... In recent decades, hospice care has grown substantially. That growth has been accompanied by concerns that for-profit hospice organizations, in particular, might be overly aggressive in pursuing patients. There have also been instances of fraud by organizations in the field. Yet, the study shows that the overall dynamics of hospice are the intended ones: People are indeed receiving palliative-type care, based around comfort rather than elaborate medical procedures, at less cost.Editor's note: This study limited its data to for profit hospice agencies. That said, its results cannot be miscontrued to provide any type of comparison between for profits and non profits, in that data from non profits was (apparently) not examined.

The case for stronger caregiver vetting in home care Home Health Care News; by Audrie Martin; 10/24/24 Direct care workers are, in many ways, the collective face of home-based care organizations. They are who clients and patients interact with. Therefore, regulators and providers are increasingly taking a closer look at who they’re hiring in the first place. While it is shocking to see caregivers commit crimes against clients, it does happen. About one in six people aged 60 and older experienced some form of abuse during 2023, according to the World Health Organization. Rates of abuse against older people have increased since the COVID-19 pandemic and are predicted to continue rising as many countries experience rapidly aging populations. To combat this trend, increased vetting is essential when hiring individuals to care for seniors in their homes. Editor's note: Related, disturbing articles we posted recently include ...

CIOs must prepare their organizations today for quantum-safe cryptography IBM; by Mark Hughes, Joachim Schäfer and Arfan Sabar; 10/24/24Quantum computers are emerging from the pure research phase and becoming useful tools. They are used across industries and organizations to explore the frontiers of challenges in healthcare and life sciences, high energy physics, materials development, optimization and sustainability. However, as quantum computers scale, they will also be able to solve certain hard mathematical problems on which today’s public key cryptography relies. A future cryptographically relevant quantum computer (CRQC) might break globally used asymmetric cryptography algorithms that currently help ensure the confidentiality and integrity of data and the authenticity of systems access.The risks imposed by a CRQC are far-reaching: possible data breaches, digital infrastructure disruptions and even widescale global manipulation. These future quantum computers will be among the biggest risks to the digital economy and pose a significant cyber risk to businesses. ... [Click on the title's link to continue reading.]

Large systems outsource home care to focus on 'core business' Becker's Hospital CFO Report; by Alan Condon; 10/25/24 A growing number of health systems are outsourcing home health and hospice operations to third-party specialists with broader geographic reach to reduce cost and administrative burdens and focus on core services. The regulatory environment for home health and hospice is complex, with stringent requirements for reimbursement, reporting and patient care standards. Partnering with an outsourced provider also helps systems mitigate the risks associated with non-compliance and operational issues. Here are four health systems that have outsourced or plan to outsource home health and hospicare care:

Change Healthcare cyberattack impacts 100 million people Becker's Health IT; by Naomi Diaz; 10/25/24 The Feb. 21 ransomware attack on UnitedHealth Group subsidiary Change Healthcare has impacted 100 million individuals. The number of impacted individuals was posted on the Office for Civil Rights Breach Portal, which is used for reporting breaches of unsecured protected health information under HIPAA. Previously, UnitedHealth said that the data stolen by hackers likely covered a "substantial proportion of people in America." The cyberattack crippled financial operations for hospitals, insurers, pharmacies and medical groups nationwide. In July, the organization began sending out breach notification letters to individuals affected by the attack.  

Diagnosed with disease he studied, Stanford doctor puts his personal story at center of new class. NBC Bay Area; 10/24/24 Stanford Medicine physician Dr. Bryant Lin is the perfect professor to teach the course “From Diagnosis to Dialogue: A Doctor's Real-Time Battle with Cancer” at Stanford. And that’s not necessarily a good thing. The class focuses on the cancer journey of a non-smoking patient diagnosed with lung cancer. Dr. Lin is that patient. “I want to take something that is obviously very negative to me personally and get some benefit out of it for at least for other people,” Dr. Lin said. 20 years ago, Dr. Lin chose a career in medicine for a simple reason. “I wanted that personal connection and that satisfaction from helping people on a day-to-day basis,” Dr, Lin said. This same motivation led Dr. Lin to co-found Stanford’s Center for Asian Health Research and Education in 2018, with a particular focus on lung cancer in non-smokers. This is why Dr. Lin was (and in a way was not) surprised when earlier this year he found himself part of the 20% of lung cancer patients who have never smoked. ...  [Click on the title's link to continue reading this inspirational story.]

The ever-rising importance of hospital chaplains RNS; by Robert L. Klitzman; 10/24/24 Frequently, chaplains are the only hospital staff member who has time to sit and speak with patients and families. ... “My religion is watching CNN,” a feisty elderly woman with cancer recently told a hospital chaplain who had knocked on the patient’s door to introduce himself. ...  [After initial resistance, they] developed a rapport, and she described her deep loneliness and terror of dying. At the end of their conversation, she felt better, grasped the chaplain’s hand firmly and said, “Thank you!” ... In recent decades, the proportion of Americans who are “religiously unaffiliated” has risen sixfold, and the percentage of “Christian” individuals has dropped about a third. Partly as a result, chaplains have, at the same time, increasingly gained training in interfaith and nondenominational approaches, and frequently see their profession as “post-religious” — extending beyond the boundaries of any one particular faith; taking nondenominational, multifaith and humanistic approaches; and commonly receiving training in counseling. With these skills they aid patients, from evangelical to agnostic, atheist and “nothing in particular,” in resetting priorities and finding sources of connection, meaning, purpose and hope. Strongly committed to aiding vulnerable and underserved populations, chaplains remind doctors to uphold the dignity of every patient.

Customizing a palliative program to patient, payer priorities Hospice News; by Jim Parker; 10/23/24 While some palliative care programs mirror the hospice model, more operators are working to tailor their services to patients’ specific needs, with varying intensity. This is increasingly important as payment shifts towards value-based payment models in which demonstrating cost savings is crucial to success. Providers need to demonstrate strong performance on quality scores as well as a track record of effectively preventing avoidable hospitalizations, readmissions and emergency department visits. This is particularly the case when negotiating contracts with Medicare Advantage plans, Accountable Care Organizations (ACOs) and other value-based payment arrangements, Sue Lynn Schramm, a partner of the hospice and palliative care consulting company Confidis, LLC, said in a presentation at the National Hospice and Palliative Care Organization Annual Leadership Conference. [Click on the title's link to continue reading.]

Telehealth vs in-person early palliative care for patients with advanced lung cancer-A multisite randomized clinical trialJAMA; Joseph A. Greer, PhD; Jennifer S. Temel, MD; Areej El-Jawahri, MD; Simone Rinaldi, ANP-BC; Mihir Kamdar, MD; Elyse R. Park, PhD, MPH; Nora K. Horick, MS; Kedie Pintro, MS; Dustin J. Rabideau, PhD; Lee Schwamm, MD; Josephine Feliciano, MD; Isaac Chua, MD, MPH; Konstantinos Leventakos, MD, PhD; Stacy M. Fischer, MD; Toby C. Campbell, MD; Michael W. Rabow, MD; Finly Zachariah, MD; Laura C. Hanson, MD; Sara F. Martin, MD; Maria Silveira, MD; Laura Shoemaker, DO; Marie Bakitas, DNSc; Jessica Bauman, MD; Lori Spoozak, MD; Carl Grey, MD; Leslie Blackhall, MD; Kimberly Curseen, MD; Sean O’Mahony, MB, BCh, BAO; Melanie M. Smith, MD; Ramona Rhodes, MD; Amelia Cullinan, MD; Vicki Jackson, MD; for the REACH PC; 9/24The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC [non-small cell lung cancer], underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery.

Annual wellness visits and early dementia diagnosis among Medicare beneficiariesJAMA Network Open; Huey-Ming Tzeng, PhD; Mukaila A. Raji, MD, MS; Yong Shan, PhD; Peter Cram, MD, MBA; Yong-Fang Kuo, PhD; 10/24Optimal dementia care depends on early recognition of cognitive impairment and timely diagnosis of Alzheimer disease and related dementias (ADRD). Optimal dementia care should reflect what matters most to patients and adhere to evidence-informed ADRD stage-specific health care. These findings indicate that AWV [annual wellness visit] recipients had a timelier first MCI [mild cognitive impairment] diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.