Literature Review

Study finds hospice providers “game” Medicare Payment Cap, but with modest impact on costs Penn LDI - Leonard Davis Institute of Health Economics; by Julia Hinkcley, JD; 9/16/25 ... Each year, about half of Medicare beneficiaries who die receive hospice services. A new study by LDI Senior Fellow and Director of Research Norma Coe and her colleague David Rosenkranz shows that some hospice agency decision-making may be intended to increase payments by undercutting the annual revenue cap that Medicare imposes. But this “gaming” of the payment rules creates only modest increases in both hospice enrollment and spending. The study’s findings also support MedPAC’s view that wage index-adjusting the cap could make it more equitable across hospice programs, but the authors caution that the MedPAC proposal to reduce the cap by 20 percent might lead some hospice providers to close, and therefore requires more analysis.

How Tampa Bay is rethinking healthcare for long-term growth Capital Analytics Associates (CAA); by Andrea Teran; 9/16/25 Tampa Bay continues to attract tens of thousands of new residents each year, while Florida’s senior population is on pace to double by 2050. In response, healthcare leaders across the region are being pushed to rethink how care is delivered, expanded, and made more equitable. ... [A session titled] "Future-Proofing Health: What Tampa Bay’s Rise as a Global Healthcare Hub Means for Communities" ... brought together executives from Tampa General Hospital, Johns Hopkins All Children’s Hospital, Empath Health, and Gulfside Healthcare Services. Over the course of the discussion, panelists explored five central themes: collaboration, access, innovation, workforce development, and the region’s evolving healthcare identity.

‘A playbook for best practices’: ASCO and COA release updated Oncology Medical Home Standards The ASCO Post; by ASCO (American Society of Clinical Oncology); 9/10/25 ASCO and the Community Oncology Alliance (COA) have released updated standards for its Oncology Medical Home (OMH) certification program, which were initially codified and published in 2021. The 2021 systematic literature review focused on the topics of OMH model of care, clinical pathways, and survivorship care plans. Among the 2025 updates are new standards that address “just culture” and safety in oncology, multidisciplinary team management, and geriatric assessment.

A workflow initiative to increase the early palliative care referral rate in patients with advanced cancer MDedge - Federal Practitioner - Quality Improvement; by Judy Lim, MD and Linda D. Nguyen, DNP, NP-C, MD; 9/3/25 ... The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice. 

The state where all hospitals have perfect health equity scores  Becker's Hospital Review; by Mariah Taylor; 9/2/25 Delaware is the only state where 100% of its hospitals scored perfectly on health equity measures, according to CMS data. The agency used hospital commitment to health equity data, such as social determinants of health data, race, ethnicity, language, gender identity, sex, sexual orientation and disability status to determine access to equitable care and coverage. Facilities were ranked on a scale of 1 to 5, with 5 being the highest score. CMS then compiled a ranking of states based on the percentage of facilities that received each score. Data was collected between January and December 2023 and was last updated Aug. 6. 

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.

Caregiving under the Medicare Hospice Benefit JAMA Internal Medicine - Viewpoint Agind and Health; by Helen P. Knight, MD; Richard E. Leiter, MD, MA; Harry J. Han, MD; 9/8/25 As palliative care physicians, we frequently refer patients to hospice care. When we do so, we often worry about them. How will they and their families manage custodial care—the day in, day out, physical and financial demands of caregiving—on top of navigating the inherent challenges of end of life? We know that high-quality hospice agencies provide patients and their families with invaluable support for symptomatic, emotional, and spiritual needs. But in the US, due to constraints of Medicare reimbursement, hospice agencies provide only limited custodial care support; this lack of assistance often is an unwelcome surprise to our patients and families and profoundly shapes their end-of-life experience.

NGHS breaks ground on philanthropy-funded hospice house Access WDUN, Gainesville, GA; by Caleb Hutchins; 9/9/25 Northeast Georgia Health System held a groundbreaking ceremony Tuesday morning for a philanthropy-funded hospice house near Gainesville. ... The project, which is expected to open in fall of 2026, is the first philanthropy-funded facility in NGHS’ history. Christopher Bray, chief philanthropy officer of the Northeast Georgia Health System Foundation, called the Stephens’ more-than $5 million donation, which kick-started the project, game-changing for the foundation and the health system at large.

Keepers of the quiet goodbye: Meet the people who pulled off a hospice miracle by overcoming society’s fear of homelessness and death itself The Oberserver, Sacramento, CA; by Scott Thomas Anderson; 9/3/25 Inside the decade-long struggle to make Joshua’s House a reality in Sacramento: Craig Dresang has lived in the shadow of death since he was 8 years old. Dresang was in third grade when his mother, Joyce, was diagnosed with stage 3 cancer. At almost the same moment, his mom’s best friend was also given a devastating cancer diagnosis. She was gone six months later — an outcome that kept flashing in Dresang’s young mind. ...  ... [Scroll ahead in time.] The child who could never run from death became the professional willing to confront it. ...  [Working with YoloCares in Davis, CA, Dresang met] Marlene von Friedrichs-Fitzwater, a woman on a mission to create the first hospice shelter for unhoused people on the West Coast.

The hidden crisis in serious illness care and how we fix itMedCityNews; by Dr. Mihir Kamdar; 9/7/25 Every year, millions of Americans with serious illnesses find themselves caught in a dangerous limbo: not sick enough to qualify for hospice, but far too ill to be served by our traditional healthcare system. The result is care that’s expensive, fragmented, and often traumatic. These patients are shuffled between a revolving door of emergency rooms and ICUs, enduring a cascade of aggressive interventions that don’t match their goals or improve their quality of life. This approach not only undermines quality, it drives healthcare spending through the roof, particularly in the last year of life. This is the hidden crisis in serious illness care. And it’s getting worse. At the root of the problem is what many in the field call the “hospice cliff.” ...

Training and practice gaps in nursing home palliative care: A cross-sectional study Journal of the American Geriatrics Society (AGS); by Manali Saraiya, Molly A. Nowels, Rose L. Carlson, Jerad H. Moxley, Catherine A. Riffin, Evan Plys, M. Carrington Reid, Isabella Hastings, Taimur Mirza, Ronald D. Adelman, Daniel Shalev; 9/7/25 We conducted a cross-sectional survey of clinical employees (N = 398) at seven NHs within a single integrated health system in New York State to (1) gauge attitudes toward and knowledge about palliative care, (2) estimate the extent of engagement with advance care planning, and (3) elicit perceptions of the most valuable components of palliative care for NH residents. ... Despite support for palliative care, gaps in knowledge and clinical engagement persist and vary by discipline. Discipline-tailored training and program design may improve palliative care delivery in NHs and help ensure more consistent, value-aligned care for residents with serious illness.

Palliative care use and end-of-life care quality in HR+/HER2- metastatic breast cancerBreast Cancer Research and Treatment; by Julia G Cohn, Susan C Locke, Kris W Herring, Susan F Dent, Thomas W LeBlanc; 8/25Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL [end of life] care. Half had some form of SPC [specialist palliative care], and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days. This real-world study demonstrates that many patients with HR + /HER2- MBC [metastatic breast cancer] receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice. 

Golden Age Manor’s new hospice suite aims to give families comfort in final days Amery Free Press, Amery, WI; by Justin Runberg; 8/28/25 With a ribbon cutting set for Sept. 4, Golden Age Manor’s newly completed hospice suite will soon open its doors, offering families a more home-like space to spend time with loved ones during end-of-life care. In partnership with Adoray Home Health & Hospice, the project has been completed, and an open house will be held for the community to view the new addition.