Literature Review

CMS to surveyors: Keep eyes open for hospice fraud Hospice News; by Jim Parker; 11/14/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a memo to accreditation bodies and state agencies advising surveyors to watch out for potential hospice fraud. The memo directs surveyors to refer issues to CMS if they suspect fraudulent activity. These actions were spurred by a rash of fraudulent hospices that have emerged primarily in California, Texas, Nevada and Arizona. “While the primary purpose of [state agencies and accreditation organization] surveys is to determine compliance with the Medicare Hospice CoPs, there are several elements of the survey process that can uncover concerns that would necessitate a referral to CMS for potential fraud,” CMS indicated in the memo. 

Person-centered care planning for people living with or at risk for multiple chronic conditionsJAMA Network Open; Brittany N. Watson, MD, MPH; Lilly Estenson, MSW; Aimee R. Eden, PhD, MPH; Maya T. Gerstein, DrPH; Maria Torroella Carney, MD; Vonetta M. Dotson, PhD3; Trisha Milnes, AuD, MHA; Arlene S. Bierman, MD, MS; 10/24This qualitative study identified 9 themes for strategies for, as well as facilitators and barriers to implementation of PCCP: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. These themes identified reforms needed and components of care delivery models to support PCCP.

Advance Directives: How to make sure your end-of-life decisions are followed Bottom Line Inc; by Mathew D. Pauley, JD; 10/24/24 Nearly 40% of older Americans have some form of advance directives, such as a living will to communicate wishes about life-saving treatment…or a medical power of attorney appointing a loved one as proxy if they’re incapacitated.  Problem: Your wishes may not always be followed in real-world situations. Examples: Emergency paramedics typically provide CPR to restart a patient’s heart even if that patient’s living will says otherwise. And complex medical circumstances at the end of life often arise that force your loved ones to make judgment calls about what you really want. Bottom Line Personal spoke to clinical ethicist Mathew Pauley about how to make sure hospitals, medical providers and family members follow your medical wishes.

How quality, compliance, technology factor into hospice recruitment Hospice News; by Holly Vossel; 10/17/24 Quality, compliance and technology investments are becoming increasingly crucial when it comes to hospices’ recruitment and retention strategies as they seek to gain an advantage in the health care labor market. Finding and keeping quality employees who are able to keep up with the fast pace of today’s hospice compliance landscape has become a challenging feat, according to SilverStone Health CEO Alfonso Montiel. The Dallas, Texas-based health system provides palliative, home health and hospice, among other services. ... More than half of hospices nationwide underwent multiple audits simultaneously during 2023, according to survey findings from LeadingAge, the National Alliance for Care at Home and the National Partnership for Healthcare and Hospice Innovation (NPHI). ...

Racial, ethnic, and socioeconomic differences in critical care near the end of life: A narrative reviewCritical Care Clinics; Katrina E Hauschildt, Judith B Vick, Deepshikha Charan Ashana; 10/24Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

The HOPE assessment tool: What you need to know [free webinar from CHAP]CHAP press release; 10/2/24The HOPE assessment tool kicks off in 2025 and will catalyze hospice care to a new level. CMS developed the HOPE tool to inform future quality measure development and payment reform, eventually moving hospice from pay-for-submission to pay-for-performance. This session will describe the implementation of the HOPE assessment tool, content highlights, and its impact on hospice program operations in the next several years.Publisher's note: Dr. Jennifer Kennedy and Kim Skehan from CHAP are presenting this free webinar 10/16/24 @ 1:00-2:00 PM ET. Please click the link above for addtional and registration information.

Suffering revisited: Tenets of intensive caring Psychiatric Times; by Harvey Max Chochinov, MD, PhD, FRCPC Patients approaching death experience many losses, including losing a sense of self. This is perhaps one of the most substantive existential challenges dying patients face, as they find the essence of who they are—along with who they were or who they want to be—under assault. This notion of disintegration or fractured sense of personhood often lies at the heart of human suffering, which Eric Cassell, MD, MACP, defined as a person’s severe distress at a threat to their personal integrity. Although suffering can often lead to feelings of hopelessness and therapeutic nihilism for patients and health care professionals, it is important for those of us who care for the dying to understand the nature of suffering and how to be most responsive and therapeutically effective. [This author's Tenets of Intensive Caring include the following:]

Competency standards for quality are needed now more than everModern Healthcare; by Stephanie Mercado; 9/11/24Stephanie Mercado is CEO of the National Association for Healthcare Quality. Healthcare quality is foundational to achieving the overarching goals of every care provider: improving population health, enhancing patient experiences, controlling costs, and more. Yet we are not where we need to be – and sustainably achieving quality and safety goals continues to be just outside of our reach. Why? New research from the National Association for Healthcare Quality reveals that people working in healthcare define quality very differently from one another. They use a range of terms like compliance, utilization management, safety, equity, population health, value. When stakeholders see quality differently and see each effort to advance quality as separate and distinct, it’s no wonder we are not further along in this quest for quality.Publisher's note: This article discusses concerns including care, cost, the workforce cliff, and how quality is achieved.

Updated Care Compare for Hospice ReleasedCMS website; 8/28/24Publisher's note: See link above to access updated Care Compare for Hospice publicly reported quality measures.

CMS rule will align hospitals with age-friendly care for older adultsBecker's Clinical Leadership; by Ashleigh Hollowell; 8/2/24Starting in 2025, a new CMS measure will require public reporting on a hospital's capability to provide age-appropriate care for older adults, the agency announced Aug. 1. The measure is included as part of its FY2025 Inpatient Prospective Payment Systems final rule. Hospitals that participate in Medicare's Hospital Inpatient Quality Reporting Program must begin to report on how they meet each element across five areas, the John A. Hartford Foundation explained via a news release shared with Becker's:

HIMSSCast: Improving patient safety and employee retention with best incident reporting practicesHealthcare IT News; by Andrea Fox; 7/26/24 By modernizing systems and improving leadership and culture to embrace reporting, healthcare organizations can better address the top 10 patient safety concerns for 2024, says Heidi Raines, founder and CEO of Performance Health Partners. Ultimately improving the quality of care healthcare systems deliver and preventing harm requires a degree of self-reflection. Along with digital transformation, putting an easy-to-use incident reporting system in place can help healthcare organizations address today's chief patient safety concerns, including medication errors, care delays, workplace violence and preventing patient falls, said Raines.

Empowering ‘deeply undervalued’ caregivers would improve ‘lifeline for older adults’ McKnights Senior Living; by Kimberly Bonvissuto; 6/28/24 Direct care workers and family caregivers remain “deeply undervalued” and often overlooked despite calls for investment in the care economy, according to the authors of a new report. “These caregivers provide a lifeline for older adults, people with disabilities, and people living with chronic conditions,” PHI and the National Alliance for Caregiving said in an issue brief released Wednesday. “Empowering them in their roles will help to ensure high quality, responsive care to meet the needs and preferences of millions of Americans now and in the future.” The organizations called on providers, Congress, the Department of Labor, the Centers for Medicare & Medicaid Services, the federal Health Resources and Services Administration, states, managed care plans and advocates to invest in the “essential partnership” between direct care workers and family caregivers. The new brief includes insights from a variety of stakeholders ...  The result is a list of recommendations that prioritize improvements to direct care jobs.Editor's Note: Our sponsor, Composing Life Out of Loss, equips hospice and palliative care organizations with caregiver education and support video libraries to strengthen relationships between the direct care professional and the family caregiver, with timely information for the entire family. Contents are written to CMS CoPs, CAHPS, and contemporary grief research; English and Spanish.

'I don't ever trust Epic to be correct': Nurses raise more AI concerns Becker's Health IT; by Giles Bruce; 6/14/24 Nurses continue to voice concerns about artificial intelligence and its integration into EHRs, saying the technology is ineffective and interferes with patient care. Nurses from health systems around the country spoke to National Nurses United, their largest labor union, for a June 5 story about issues with such programs as automated nurse handoffs, patient classification systems and sepsis alerts. Multiple nurses cited problems with EHR-based programs from Epic and Oracle Health that use algorithms to determine patient acuity and nurse staffing levels. "I don't ever trust Epic to be correct," Craig Cedotal, RN, a pediatric oncology nurse at Kaiser Permanente Oakland (Calif.) Medical Center, told the nurses' union. "It's never a reflection of what we need, but more a snapshot of what we've done." ... Hundreds of nurses protested AI at Kaiser Permanente San Francisco Medical Center in April.