Literature Review

Generative AI is supposed to save doctors from burnout. New data show it needs more trainingSTAT+; by Casey Ross; 4/25/24After stratospheric levels of hype, early evidence may be bringing generative artificial intelligence down to Earth. A series of recent research papers by academic hospitals has revealed significant limitations of large language models (LLMs) in medical settings, undercutting common industry talking points that they will save time and money, and soon liberate clinicians from the drudgery of documentation.

Hospice handoffs may lower odds of Medicare denials Medscape, by Lara Salahi; 4/29/24Clearer communication between primary care clinicians and hospice providers may decrease the number of denied Medicare approvals for end-of-life treatment, according to a small study presented on April 18 at the American College of Physicians Internal Medicine Meeting 2024. Tyler Haussler, MD, acting medical director at  Brookestone Home Health & Hospice in Carney, Nebraska, said he conducted the study. ... CMS requires a "face-to-face encounter" between a physician and hospice caregiver to communicate clinical findings and determine the patient's terminal status. Missing or incomplete documentation of a patient's medical condition remains one of the main reasons the agency denies hospice coverage. 

New study calls home health star ratings into question McKnights Home Care, by Adam Healy, 4/11/24A comparison of agency-reported functional measures and claims-based hospitalization measures raises doubts about the value of star ratings as a means of evaluating home health agency (HHA) quality. The study, published Wednesday in JAMA Network Open, analyzed differences between claims-based and agency-reported outcomes for nearly 23 million patient episodes before and after the introduction of the star ratings system to compare changes over time. 

Elevating quality, outcomes, and patient experience through Value-Based Care: CMS Innovation Center’s Quality PathwayNEJM Catalyst; by Susannah M. Bernheim, MD, MHS; Noemi Rudolph, MPH; Jacob K. Quinton, MD, MPH; Julia Driessen, PhD; Purva Rawal, PhD; and Elizabeth Fowler, PhD, JD; 4/3/24The U.S. Center for Medicare and Medicaid Innovation is launching a new Quality Pathway to elevate patient-centered quality goals in the design and evaluation of alternative payment models. The Quality Pathway will align model design around quality goals; elevate outcomes and experience measures, particularly patient-reported outcomes; and ensure that evaluations have the ability to assess the impact of models on primary quality goals. These determinations will help the Innovation Center make critical decisions about which models to scale or expand in the pursuit of improving the quality of care for people with Medicare and Medicaid.

Hospice providers serving assisted living residents: Association of higher volume with lower qualityJournal of American Geriatrics Society; by Wenhan Guo MS, MA, Helena Temkin-Greener Phd, Brian E. McGarry PT, PhD; 3/27/24Background: Assisted living (AL) community caregivers are known to report lower quality of hospice care. However, little is known about hospice providers serving AL residents and factors that may contribute to, and explain, differences in quality. We examined the association between hospice providers' AL patient-day volume and their quality ratings based on Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Surveys.

Private equity more common in Massachusetts health care: Steward crisis has state on hunt for possible legislative response 22 News WWLP.com; by Ashley Shook, Alison Kuznitz, Chirs Lisinski; 3/26/24 The pressure points inflicted by private equity ownership in health care extend far beyond Steward Health Care, and lawmakers have a long menu of policy reforms they can consider to erect new guardrails in a changing environment, experts said Monday. Pushed into public-facing action after a long-simmering financial crisis at Steward burst into public view this year, lawmakers convened a public hearing to explore how deeply private equity has taken root in the Bay State’s health care system and what policymakers should do to prevent harm to patient care. 

Improving the Quality Of Quality Metrics Health Affairs; by Aditya Narayan, Bob Kocher, and Nirav R. Shah; 3/19/24... The landscape of health care quality measures is dynamic, reflecting efforts to enhance patient care, safety, and outcomes. These measures are developed and reimbursed by a variety of stakeholders, including government agencies such as the Centers for Medicare and Medicaid Services (CMS), health care organizations, and independent bodies such as the National Quality Forum and the Agency for Healthcare Research and Quality (AHRQ). The development process involves rigorous research, stakeholder engagement, and consensus-building to ensure measures are evidence-based, applicable across different health care settings, and meaningful to patient care.Editor's Note: Read and share this informative, big-picture article about the evolution of healthcare's quality metrics, its tools, and best practices. 

Reducing adverse events with clinical audit Healthcare Connection; by Annette Schandl, George Bezzerides, Erin Meyer; 3/19/24 Patient safety is at the core of healthcare. Yet, clinical audits remain underrepresented on many healthcare organizations’ internal audit plans. ... Planning clinical audits: A checklist ...

79 best hospitals for patient experience, safety: Healthgrades Becker's Clinical LeadershipHealthgrades recognized 832 hospitals with its 2024 Patient Safety Excellence Awards and Outstanding Patient Experience Award. Only 79 of those hospitals received both awards. The dual recipients spanned 27 states. Texas had the most dual recipients with 13 honorees — including four Baylor Scott and White Health and four Houston Methodist hospitals. [Click here for] the 79 hospitals that received both Patient Safety Excellence and Outstanding Patient Experience awards, listed by state.

The devil’s in the details: Hospice providers face Claim Denials for Election Statement technicalities JDSupra, by Lanchi Nguyen Bombalier and Charmaine Mech; 2/29/24Since the Centers for Medicare & Medicaid Services (“CMS”) paused much of its audit activity during the COVID Public Health Emergency, the most recent rounds of Medicare audit activity may represent the first “look” at the new Election Statement forms that many hospice providers adopted under the new Medicare election statement requirements effective in October 2020. Unfortunately, these initial audit results from the Medicare Administrative Contractors (“MACs”) suggest that hospice providers and MAC reviewers may not necessarily see eye-to-eye on what information must be included in the new Election Statement.

NHPCO celebrates achievements of hospice and palliative care providers in nationwide Quality Connections Program NHPCO press release; 2/13/24The National Hospice and Palliative Care Organization (NHPCO) recognizes the achievements of participating member organizations who have earned rings in the third program year of NHPCO’s Quality Connections program. First launched in January 2021, Quality Connections (QC) is the only national program designed to support hospice and palliative care provider delivery of high-quality, person-centered care. The program is structured around four fundamental pillars which are represented by four rings: Education, Application, Measurement, and Innovation.

Concurrent Medicare hospice & curative care improves quality & reduces costs 13%Open Minds; 2/7/24Medicare beneficiaries with terminal health conditions who participated in the Medicare Care Choices Model (MCCM), received high quality care at a 13% lower cost compared to similar beneficiaries who did not receive the MCCM services. The Centers for Medicare & Medicaid Services (CMS) tested this new model as an option for Medicare beneficiaries to receive supportive care services while continuing to receive services for their terminal condition.