Literature Review

Patients with suboptimal discharges – a follow-up (and rescinding hospice billing)RACmonitor; by Ronald Hirsch, MD, FACP, ACPA-C, CHCQM, CHRI; 10//28/26 Let me start with an update on my project to get a way to indicate on a hospital claim that a patient has discharged to a less-than-optimal location. ... [That began] with a push to use the “against medical advice” designation for such patients. But the stigma behind that term led me to adopt the suggestion of Valerie Rinkle, a nationally known revenue integrity expert, who proposed adoption of a condition code instead of using a discharge status code. Last week I once again presented to the National Uniform Billing Committee (NUBC), asking for such a code to be established. During that meeting, one of the members came up with an even better idea: establishing two condition codes, one for when the patient chooses a less-than-optimal location, and a different condition code for when the payer refuses to approve the suggested post-acute care.

The debate: vertical integration, payvider, or world-class care—which path forward? | part one Teleios Collaborative Network (TCN); podcast by Chris Comeaux; 10/21/26 What if hospice succeeds at the wrong strategy?  Chris Comeaux explores three paths for the future of hospice and palliative care: vertical integration, the payvider model, and world-class specialty care. In Part One of The Debate: Vertical Integration, Payvider, or World-Class Care—Which Path Forward?, Chris Comeaux confronts a defining question for healthcare leaders: What should our organizations become to best serve patients and families? With competition intensifying, financial pressures mounting, and workforce demands growing, he introduces three possible paths: build an Vertical Integration continuum of care, participate in financing as a Payvider, or make World-Class Hospice and Palliative Care the central strategy.

The debate: vertical integration, payvider, or world-class care—which path forward? | part one Teleios Collaborative Network (TCN); podcast by Chris Comeaux; 10/21/26 What if hospice succeeds at the wrong strategy?  Chris Comeaux explores three paths for the future of hospice and palliative care: vertical integration, the payvider model, and world-class specialty care. In Part One of The Debate: Vertical Integration, Payvider, or World-Class Care—Which Path Forward?, Chris Comeaux confronts a defining question for healthcare leaders: What should our organizations become to best serve patients and families? With competition intensifying, financial pressures mounting, and workforce demands growing, he introduces three possible paths: build an Vertical Integration continuum of care, participate in financing as a Payvider, or make World-Class Hospice and Palliative Care the central strategy.

The debate: vertical integration, payvider, or world-class care—which path forward? | part one Teleios Collaborative Network (TCN); podcast by Chris Comeaux; 10/21/26 What if hospice succeeds at the wrong strategy?  Chris Comeaux explores three paths for the future of hospice and palliative care: vertical integration, the payvider model, and world-class specialty care. In Part One of The Debate: Vertical Integration, Payvider, or World-Class Care—Which Path Forward?, Chris Comeaux confronts a defining question for healthcare leaders: What should our organizations become to best serve patients and families? With competition intensifying, financial pressures mounting, and workforce demands growing, he introduces three possible paths: build an Vertical Integration continuum of care, participate in financing as a Payvider, or make World-Class Hospice and Palliative Care the central strategy.

Value-based care and alternative payment models: What they are and how they workHealthcare Financial Management Association (HFMA); by HFMA; 9/20/26Value-based care (VBC) is an approach to healthcare that seeks to improve the quality, outcomes and experience of care while managing its cost. Rather than rewarding healthcare organizations solely for the volume of services they provide, value-based arrangements link some or all payment to measures of quality, outcomes, utilization or total cost of care.

Hospice tech execs have changing role in age of AI Hospice News; by Jim Parker; 9/30/26 The proliferation of artificial intelligence (AI) in the hospice space is changing how chief information officers and other technology-focused leaders are approaching their jobs. Hospices nationwide are investing in AI systems to transform virtually every aspect of their businesses. This includes both nonprofit and for-profit providers and organizations of all sizes, though larger, well-capitalized companies and investing more heavily.

EvergreenHealth receives transformative $100M gift from Dean Weidner The Bee, Kirkland, WA; Press Release; 9/28/26 EvergreenHealth has received a philanthropic gift of $100 million from Dean Weidner—the largest gift in the community-owned hospital’s history. This transformative donation helps accelerate EvergreenHealth’s plans to advance high-quality health care in the community with expanded access and increased capacity for generations to come. The gift honors the legacy of Dean Weidner and his wife, Ana, both dedicated philanthropists and advocates for EvergreenHealth’s mission to advance the health of the community through safe, compassionate, cost-effective health care. ...EvergreenHealth is two-hospital health system with a network of primary care practices, urgent care centers, specialty clinics, extensive home care and hospice services, and 24/7 emergency care in Kirkland, Monroe and Redmond.

Hospice industry generates $142 million in economic activity [in Puerto Rico] W Journal; by Newsroom; 9/24/26 Puerto Rico’s hospice industry generates an estimated $142 million in economic activity, supports approximately 1,417 jobs and produces nearly $48 million in annual payroll, according to a new study by Estudios Técnicos Inc. (ETI). Commissioned by Grace Health Puerto Rico, the study examines the industry’s economic impact and the potential cost benefits of hospice care compared with more intensive forms of end-of-life treatment. ... “The findings demonstrate that hospice services generate not only economic benefits, but also important social benefits for patients and their families,” said Anitza Cox Marrero, director of ETI’s Social Analysis Division.

2027 trends to watch: Distributed care will drive the next phase of healthcare delivery Definitive Healthcare; by Ethan Popowitz; 9/17/26 Healthcare delivery has never been confined to a single setting. But the number of places where patients can receive care, and the range of services available outside the hospital, have grown in recent years. Today, a single patient journey might include a primary care visit, diagnostic imaging at an outpatient center, a procedure at an ambulatory surgery center (ASC), a virtual follow-up, and remote monitoring from home. ... This more distributed model of healthcare delivery is being shaped by several forces at once, from advances in medical technology and economic pressures to workforce shortages and more. 

CMS recalculating 2027 hospice payment rates due to errorHospice News; by Jim Parker; 9/8/26 The 2027 hospice payment rates likely will change based on a technical error by the U.S. Centers for Medicare & Medicaid Services (CMS). The agency made a mistake that affected the Fiscal Year 2027 hospice wage index and has recalculated those numbers. CMS is in the process of developing a correction notice to update the wage index and hospice payment rates for all four levels of care. This will not require another proposed rule.

CMS oversight did not prevent Medicare Part D sponsors from making $587.7 million in ineligible payments to pharmacies for drugs available over the counter but labeled as prescription-only United States Government HHS-OIG; Report number OAS-24-02-004; issued on 8/31/26, posted on 9/2/26 

Wound care fraud: key insights for healthcare providers in 2026 JD Supra; by Lynette Byrd; 8/21/26 The U.S. Department of Justice (DOJ) and U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) are prioritizing wound care fraud enforcement in 2026. Healthcare providers are facing scrutiny under the False Claims Act and Anti-Kickback Statute, with audits and investigations leading to substantial liability (among other consequences) in many cases. ... Allegations of wound care-related health care fraud can take many different forms. ... While it is critical that elderly patients (including hospice patients and other terminally ill patients) receive appropriate care, there are limits to what is considered appropriate when billing Medicare or Medicaid for wound care. ...

CMS hospice payment suspensions slamming vendors Hospice News; by Jim Parker; 8/21/26 ... CMS earlier this year began suspending Medicare payments to hundreds of hospices allegedly due to suspected fraud. ... Evidence indicates that some legitimate hospices were caught up in the dragnet due to patients being discharged for valid reasons, such as a revocation of the benefit, moving out of a provider’s service area or transfer to another hospice. ... These regulatory actions have had a ripple effect on vendors, according to a DME company CEO that spoke to Hospice News on background. “These hospice agencies are being suspended. They’re not getting paid,” the DME CEO told Hospice News. “If they’re not getting paid, their employees are not getting paid. DME providers like us are not getting paid. Pharmacies are not getting paid. Any other contractor they have is not getting paid.” This has placed some vendor businesses in peril, and some of them have been considering layoffs of their own, another DME provider ... told Hospice News, “We’ve been trying to keep everybody on board, keep them employed, keep them paid for as long as we possibly can.”