Literature Review

The future of claims management: How payers can maximize payment integrityBecker's Payer Issues; 12/29/237 to 10 cents of every dollar spent on healthcare goes toward paying for fraudulent claims. Learn the latest strategies for boosting payment integrity here.

The experience of Rosalynn and Jimmy Carter helps widen the perception of hospiceBy Heath BartnessTwin Cities Pioneer PressDecember 28, 2023In 2023 the public benefited from the willingness of President Jimmy Carter and his family to openly share their health updates. Hospice care has gotten a renewed focus, and the Carters’ end-of-life journey is illuminating a complicated story of hospice use in the United States. Different sides of the same coin, the hospice experiences of President and Mrs. Carter are kindling a much-needed conversation around this underused service. ... Barriers to hospice care are not so much financial or geographical. In many ways, the greatest barrier to hospice is emotional. 

Mercy medical record transition heats up in bankruptcy courtThe Gazette (Cedar Rapids, IA)December 22, 2023Iowa City, IA—Among the complexities of a Mercy Iowa City bankruptcy sale to the University of Iowa is the transition of its electronic medical system—with any gap or abrupt termination of system operations posing “significant” threat to Mercy and its patients. 

Labor activity in long-term care may be poised for ‘enormous’ growth in 2024McKnight’s Long Term Care NewsDecember 21, 2023Heightened union activity frequently made headlines this year, including among healthcare workers who loudly raised concerns about pay and staffing. Multiple factors make it likely that the trend of rising labor activity in long-term care will continue in 2024, experts say. 

Racial and Ethnic Disparities Seen in Use of HospiceHealthDayDecember 18, 2023Racial and ethnic disparities are seen in use of hospice among Medicaid recipients, according to a study published online Dec. 8 in JAMA Health Forum. Julie Robison, Ph.D., from the UConn Health Center on Aging in Farmington, and colleagues compared hospice use and hospice length of stay (LOS) by race and ethnicity among Medicaid-only individuals and those with dual eligibility for Medicare and Medicaid (duals). 

Can AI Help You Die? Doctors in New Jersey are experimenting with software to prompt discussions with patients about palliative or hospice care.BloombergDecember 18, 2023Doctors can be slow to talk about the end of the traditional medical road. When they’ve been trying to manage a life-threatening illness or keep a terminal patient alive, bringing up palliative or hospice care can feel like giving up. But these options can radically improve quality of life, or the end of life, when traditional medicine hasn’t helped enough—if patients and their doctors figure it out in time. ... “When someone is actively declining, you can see it, but being able to predict before that happens is hard.” Can artificial intelligence software do a better job than humans of picking that moment? That’s the idea behind Serious Illness Care Connect, a software tool that about 150 doctors are testing in a pilot program in New Jersey’s largest health-care network, Hackensack Meridian Health. ... The Hackensack Meridian team stresses that the tool isn’t making decisions. “Think of this as a ‘check engine’ light,” says Lauren Koniaris, the chief medical informatics officer at Hackensack Meridian.

‘Tougher Every Day’—Nursing Home Operators, CCRCs Weigh in on Future of Skilled NursingSkilled Nursing NewsDecember 14, 2023Operating a skilled nursing facility today is considered a “tough business” with regulations and reimbursement woes making the space “tougher every day.” Other operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. 

NAHC President Bill Dombi—History Repeating Itself on Hospice Program IntegrityHospice NewsDecember 14, 2023Issues of fraud in the hospice industry echo events that previously affected the home health space, and providers can learn from that prior experience. This is according to Bill Dombi, president of the National Association for Home Care and Hospice, who spoke Thursday in a Relias webinar. ... “What I’m seeing is history repeating itself. Back in the 1990s, the microscope ended up focusing on the Medicare Home Health Program. 

Telehealth use among seniors back up to pandemic-era highs, one company claimsMcKnight’s Senior LivingDecember 13, 2023Nearly all seniors in the US, an astonishing 97%, had at least one telehealth appointment this year, a new survey indicates. The data, which comes from remote platform operator Independa, indicates that telehealth usage among seniors has grown 20% over the past three years, nearly back up to the pandemic-era peak, when in-person options were not available. 

Study uncovers racial inequalities in hospice utilization, length of stayMcKnight’s Home Care DailyDecember 12, 2023Blacks and Hispanics are less likely to use hospice services, and those who do often have shorter lengths of stay than white patients, according to a new study published in JAMA Health Forum. ... Minority patients also generally experienced shorter hospice lengths of stay. Hispanic patients in particular were more than twice as likely to stay in hospice care for seven days or less, compared to the average white Medicaid beneficiary. Still, short length of stay was relatively common across the board at about 40%, which suggests “room for improvement in referring all Medicaid recipients to hospice earlier in the course of terminal illness,” the study’s authors wrote. As to possible reasons for these disparities, the researchers noted that language barriers, mistrust of hospice programs or cultural differences might be at play. But also, the inequity might also reflect “potential racial biases that affect who a physician is more likely to refer to hospice,” according to the study. Specific, targeted efforts to encourage hospice services for Medicaid and dual-eligible beneficiaries who show low rates of utilization may help to overcome these disparities.

‘Hospice is more about living better’ transitional care director says of misunderstood programTribune-Review (Pittsburgh, PA)December 11, 2023... There is an assumption a patient entering hospice care is not expected to live beyond six months, a guideline that is tied to Medicare coverage. But the experience of individual patients can vary widely, as evidenced by [senior living residents] the Pattersons [Robert, 97, and Joyce, 90,] and by former president Jimmy Carter and his late wife, Rosalynn. Like many who elect to receive hospice care, Rosalynn Carter entered the program toward the very end of her life—just days before her death Nov. 19, at 96. But it’s also possible for patients to beat the odds and have hospice care extended. Jimmy Carter was 98 when he entered hospice in February and continues to endure. 

Shifting focus to MA will alter ‘life as we know it’ for home care providers, experts sayMcKnight’s Home Care DailyDecember 7, 2023Medicare Advantage is disrupting the traditional home care landscape, experts from the Research Institute for Home Care said in a webinar hosted Wednesday afternoon by the National Association for Home Care & Hospice. As MA continues to dominate Medicare and cover those beneficiaries receiving home health, certain trends—such as access issues or shifting utilization rates for services within traditional Medicare—have become more pronounced. “Medicare Advantage is growing, and that’s going to result in a decreased volume in home health claims among traditional Medicare beneficiaries,” Elizabeth Hamlett, senior research associate for evaluation and health economics at KNG Health, said during the webinar about the recently released 2023 RIHC [Research Industry for Home Care] Chartbook. Home health users in general also may become more reflective of the characteristics of MA beneficiaries—which essentially means sicker and poorer, she said. ... However, MA and fee-for-service beneficiaries showed greater variation in their reported access to home health services. “What we’re seeing here is potentially an access problem for Medicare Advantage users,” Hamlett said.