Literature Review

National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade Health Affairs - Research Article - Costs & Spending; by Jacqueline A. Fiore, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Sean P. Keehan, Kathryn E. Rennie, and Alyssa C. Gross; 6/12/24 Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. ... Amonth eh major payers, Medicare has the highest projected ten-year average spending growth rath, mainly because of enrollment into the program. [Click on the title's link to examine this article's content and tables.]

How the Supreme Court’s Chevron Decision could help stop home health cuts Home Health Care News; by Andrew Donlan; 6/28/24 On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward. The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year. Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. ... The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023. “In our own analysis, we believe that providers of home health have been underpaid as it relates to budget neutrality,” NAHC President William A. Dombi said when the lawsuit was filed. “At minimum, we would expect to see the rate cuts from 2023, that were permanent readjustments to the base rate, and the one proposed for 2024, along with the temporary adjustments … to go away. The end product of that is that we would have a stable system to deliver home health services to Medicare beneficiaries.”

‘Lot of work to be done’: What home health leaders expect from payment rulemaking in 2024Home Health Care News; by Joyce Famakinwa; 6/24/24 In recent years, home health care has faced relentless cuts from the Centers for Medicare & Medicaid Services (CMS). It has plagued the industry, but providers and advocates alike are still hopeful a light at the end of the tunnel is ahead. ... Home Health Care News recently caught up with PQHH CEO Joanne Cunningham and David Totaro, the president and executive director of Hearts for Home Care. ... [Cunningham said,] "I anticipate that what we will see, given CMS’s posture and prior rulemaking cycles, is the continuation of the policy that will put in place permanent cuts to the Medicare home health program. We’re bracing ourselves for an additional sizable permanent cut. We don’t know exactly what CMS has planned for the temporary cuts, otherwise known as the clawback cuts. We will certainly see, at a minimum, CMS identify what their new projected value of the temporary cuts are. ...

Hospice care company owner sentenced on health care fraud charges United States Attorney's Office - Western District of Louisiana; Press Release; 6/20/24 United States Attorney Brandon B. Brown announced that Kristal Glover-Wing, 51, formerly a resident of Broussard, Louisiana, and now living in California, has been sentenced for conspiracy to commit health care fraud and three counts of health care fraud. United States District Judge Robert R. Summerhays sentenced Glover-Wing to 72 months in prison, followed by 3 years of supervised release.  She was also ordered to pay $3,675,948.42 in restitution. ... Glover-Wing was the owner of Angel Care Hospice (“Angel Care”), a Louisiana corporation that purported to provide hospice services in Lafayette Parish and other parishes in the Western District of Louisiana. Through evidence presented at trial, jurors learned that from approximately 2009 through 2017, over 24 patients were placed on hospice by Angel Care without meeting the criteria required by Medicare. During the time period that the patients were on hospice and under the care and supervision of Angel Care, none of them had been diagnosed with a terminal condition. In fact, many of the patients themselves, who are still alive and thriving many years later, as well as family members of other patients, testified that they never knew that they had been placed on hospice. 

HHS to end Medicare pay program after Change Healthcare breach Bloomberg Law; by Tony Pugh; 6/17/24The Biden administration announced plans Monday to terminate a program that provided more than $3.2 billion in accelerated and advance Medicare payments to hospitals, physicians, and others suffering cash flow disruptions following the Change Healthcare cyberattack in February. Medicare payments under the Accelerated and Advance Payment (AAP) Program for the Change Healthcare/Optum Payment Disruption (CHOPD) will end on July 12, the Centers for Medicare & Medicaid Services announced.

AAHPM CMO Joe Rotella: Hospice does not exist to save money Hospice News; by Jim Parker; 6/17/24Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM), calls on hospices to maintain their core principles amid a churning sea of regulatory and economic changes. Rotella began his medical career as a primary care physician in a small, rural town in central New Hampshire, where he stayed for 12 years [followed by serving Hospice & Palliative Care of Louisville, KY/Hosparus as Chief Medical director for 15 years]. ... Now, Rotella will soon retire from AAHPM. Hospice News sat down with Rotella to discuss the ways hospice and palliative care have changed during his tenure in the space, as well as the forces shaping the field’s future. ...

Kickbacks and medically unnecessary treatments: Five major qui tam settlements from May 2024 JD Supra; by Geoff Schweller; 6/5/24 Under the FCA’s qui tam provisions, a crucial tool in combating healthcare fraud, whistleblowers have the power to file suits on behalf of the federal government if they possess the knowledge of an individual or company defrauding the government. The government may choose to intervene and take over the suit, but if a qui tam lawsuit results in a successful settlement, the whistleblower is eligible to receive between 15-30% of the monies collected. The settlements announced in May cover a wide range of alleged misconduct that violates the FCA, including cases concerning kickbacks and the billing of federal healthcare programs for medically unnecessary treatments. Each settlement represents a victory in the ongoing battle against fraud. ... [Non-hospice examples followed by this hospice case] $4.2 Million Settlement with Elara Claring for Allegedly Billing Medicare for Ineligible Hospice Patients ...

How hospice valuations are shaping up in 2024Hospice News; by Jim Parker; 5/30/24When it comes to hospice acquisitions, buyers’ and sellers’ expectations on price tags are becoming more aligned. A surge of deals in 2021 and 2022 led to record-high valuations in the space with multiples reaching in excess of 30x in some instances. While many buyers were willing to pay that premium, some stepped out of the market due to the high valuations. But deal volume has largely declined in late 2023 and early 2024, and valuations are starting to come down.

BetterRX and Hospice Dynamix announce strategic partnership to reduce pharmacy costs for hospice agencies NBC News Channel 8, Salt Lake City, UT; by EIN Presswire; 5/31/24 BetterRX, a leading hospice pharmacy services and technology provider, and Hospice Dynamix, a revolutionary time-on-service predictive analytics platform, today announced a strategic integration partnership. This collaboration will leverage Hospice Dynamix's proprietary Predicted Length of Stay (PLOS) technology to enhance BetterRX's proprietary medication ordering and management platform, enabling hospice providers to make ordering decisions based on the individual patient, creating immediate savings for the hospice.

Hospice CAHPS scores updated 5/22/24CMS CAHPS® website; multiple updates posted 5/22/24 CMS has posted numerous CAHPS® Hospice Survey updates. Click on the title's link to access the CMS site. Click on "Care Compare Reporting Updates" or the following 5/22/24 updates:

Healthcare sees highest Chapter 11 bankruptcy filings in 15 years: reportMcKnights Senior Living; by Kathleen Steele Gaivin; 5/20/24Chapter 11 bankruptcies in healthcare, including senior living reached a multiyear high in the first quarter of 2024. That’s according to the newest Polsinelli-TrBK Distress Indices Report, published Wednesday. “We continue to see intense stress in senior living,” Jeremy R. Johnson, a bankruptcy and restructuring attorney at Polsinelli and co-author of the report, said in a press release issued in conjunction with the report. ... The Southeast continues to outpace the rest of the country as the busiest region for bankruptcy filings, according to the report. The Southeast region reported 33.4% of the filings in the first quarter, followed by Northeast and Delaware at 30.8% and 16.1%, respectively. Since the benchmark period of 2020, the Northeast has shown the biggest increase in filings.

Senate ramps up push to reform doctors' Medicare pay Modern Healthcare; by Michael Mcauliff; 5/20/24Declining doctors' pay in Medicare is getting its most serious look in nearly a decade in the Senate, with a bipartisan push launched Friday by the Senate Finance Committee. Doctors have grown especially vocal in recent years about falling Medicare reimbursement. Groups including the American Medical Association have estimated doctors were effectively getting paid 26% less in 2023 than in 2001 because the physician fee schedule set by the Centers for Medicare and Medicaid Services is not adjusted for inflation. Physicians have also called for more flexibility within the pay system.

California to redirect more than $7B in healthcare funding Becker's Hospital CFO Report; by Mackenzie Bean; 5/13/24 California is seeking to divert more than $7 billion in funding from the healthcare sector to address a major funding deficit, according to a revised budget proposal released May 10. Gov. Gavin Newsom has proposed reallocating $6.7 billion from Medi-Cal provider rate increases planned for Jan. 1, 2025, to balance the state budget. This funding was generated by the managed care organization tax created last year. ... The proposed budget would also cut funding for healthcare workforce initiatives by $854.6 million through 2028. Funding for public health and various behavioral health programs would also be reduced.