Literature Review

Seven of thirty hospices reviewed did not comply or may not have complied with terms and conditions and federal requirements for Provider Relief Fund payments HHS Office of Inspector General; issued on 11/8/24, posted on 11/14/24Why OIG Did This Audit: The Provider Relief Fund (PRF), a $178 billion program, provided funds to eligible providers for health care-related expenses or lost revenue attributable to COVID-19. ... This audit is part of a series reviewing PRF payments to various provider types. Specifically, this audit assessed whether 30 selected hospices expended taxpayer funds in accordance with Federal and program requirements. ... What OIG Found: ... Of the 30 selected hospices, 23 hospices used PRF funds for allowable expenditures and lost revenues attributable to COVID-19; however, 7 hospices did not comply with or may not have complied with Federal requirements. Of these seven hospices, which received $98.1 million in PRF payments, six hospices claimed a total of $8.3 million of unallowable PRF expenditures and inaccurately reported $1.5 million of lost revenues, and one hospice claimed $4 million in expenditures that may not have been allowable. ... What OIG Recommends: We made two recommendations to HRSA, including that it require the selected hospices to return any unallowable expenditures to the Federal Government or ensure that the hospices properly account for these expenditures. ...

Long-term care market to grow by USD 394.8 billion from 2024-2028, as aging population drives demand with AI impact on market trends - Technavio Cision; by PR Newswire; 11/8/24 Report on how AI is redefining market landscape - The global long-term care (LTC) market size is estimated to grow by USD 394.8 billion from 2024-2028, according to Technavio. The market is estimated to grow at a CAGR of over 3.21% during the forecast period. Growing demand for long-term care from aging population is driving market growth, with a trend towards expansion and growth of several healthcare domain. However, lack of skilled nursing staff for long-term care  poses a challenge.Key market players include Abri Health Care Services LLC, Amedisys Inc., Brookdale Senior Living Inc., CareOne Management LLC, Diversicare Healthcare Services Inc., Extendicare Canada Inc, FCP Live In, Genesis Healthcare Inc., Honor Technology Inc., Illumifin Corp., Kindred Health Holdings LLC, Life Care Centers of America Inc., Revera Inc., SeniorLiving.org, Sonida Senior Living Inc., Sunrise Senior Living LLC, and Wickshire Senior Living.

The Pennant Group to seek more hospice, home health deals in 2025 Hospice News; by Jim Parker; 11/7/24 The Pennant Group (Nasdaq: PNTG) has a “robust pipeline” of potential acquisitions in the wings for 2025 across its home health and hospice and senior living business segments. For prospective deals, Pennant scouts for agencies that show strong promise for organic growth that have “talented” local leaders or entrepreneurs in place, according to CEO Brent Guerisoli. Pennant then leverages the resources in its platform to foster growth. “Developing local leaders remains at the heart of our operating model,” Guerisoli said in a Q3 earnings call. “As the talent and experience operations and clusters deepens with strong portfolio companies, our efforts throughout our footprint, we are able to more quickly improve new acquisitions and grow seasoned operations, thus the significant investment we have made in our leadership and development programs is the catalyst for enduring momentum.” Pennant is the holding company for a cluster of independent hospice, home health and senior living providers located across 13 states. Year to date, the company has added more than 60 CEOs to its portfolio agencies as well as 40 internal clinical leaders.

Why home health deserts are spreading across rural states Modern Healthcare; by Diane Eastabrook; 11/1/24 Home health deserts are increasing at an alarming rate across some rural states as home health companies close or reduce services due to financial challenges. Home health companies in Maine, Nebraska and Minnesota say a proposed Medicare rate cut, low Medicare Advantage reimbursements and workforce shortages are forcing them to make difficult business decisions — leaving many communities with limited access or no access to post-acute care in the home. ...  Approximately 800 home health providers have closed over the past five years, according to the National Alliance for Care at Home, a trade group that represents the industry. Alliance CEO Dr. Steve Landers mostly blames a Medicare home health payment model that went into effect in 2020 for reducing Medicare reimbursements and causing financial stress for providers. “While closures are significant, we are also getting reports that providers are restricting the territory they serve as a first step to addressing their financial stresses,” Landers said in an email. “This appears to be especially concerning in rural areas where no other provider is available to step in.”

Longer hospice stays among dementia patients save Medicare dollars Hospice News; by Holly Vossel; 11/4/24 Hospice utilization has tripled among patients diagnosed with Alzheimer’s disease and related dementias (ADRD) during the past two decades. The trend has ignited concerns about these patients’ lengths of stay, as well as praise for hospices’ cost-savings potential. Massachusetts Institute of Technology (MIT) researchers analyzed Medicare fee-for-service claims spanning between 1999 and 2019, including data on hospice billing, patient enrollment, hospitalizations, health costs and chronic condition indicators. Roughly 14.7% of ADRD patients utilized hospices services in 2019, nearly triple the 4.4% of patients who received this care in 1999, according to the research, which was published in the National Bureau of Economic Research. The research compared billing claims among nonprofit and for-profit providers to explore spending associated with longer hospice stays among dementia patients. ...

CMS finalizes 2.9% cut in physician payments for 2025, including for palliative care Hospice News; by Jim Parker; 11/4/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized a nearly 2.9% cut for 2025 in physician payment rates used to reimburse palliative care care practitioners, among other professionals. The final rule also states that the telehealth flexibilities implemented during the COVID-19 public health emergency will expire at the end of this year unless Congress intervenes. Physicians and other professionals will have to follow pre-COVID restrictions on telehealth, with few exceptions. Industry organizations were quick to denounce the pay cut. “To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” American Medical Association President Dr. Bruce Scott said in a statement.

Medicare Part D paid millions for drugs for which payment was available under the Medicare Part A Skilled Nursing Facility Benefit HHS Office of Inspector General; Report Highlights; 10/27/24 What OIG Found: ... On the basis of our sample results, for 2018 through 2020, we estimated that up to the entire Part D total cost of $465.1 million was improperly paid for drugs for which payment was available under the Part A SNF benefit. Of that amount, we estimated that approximately $245.4 million was for drugs that the medical records showed were administered to Part D enrollees during their Part A SNF stays.What OIG Recommends: We made five recommendations, including that CMS work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Part A SNF benefit; work with its plan sponsors to identify similar instances of noncompliance that occurred during our audit period and determine the impact to the Federal Government, which could have amounted up to an estimated $465.1 million in Part D total cost; and provide plan sponsors with timely and accurate information, such as dates of covered Part A SNF stays, to reduce instances of inappropriate Part D payment for drugs for which payment is available under the Part A SNF benefit. ... CMS concurred with all five recommendations.

Southern Tier Health helps HomeCare & Hospice, Total Senior Care on USDA grant Olean Times Herald, Olean, NY; by Kellen M. Quigley; 10/22/24 A collaboration between three local agencies looking out for the health and well-being of their clients is getting a modern technological boost thanks to a federal grant. The Southern Tier Health Care System, Inc. (STHCS) was recently awarded nearly $140,000 through the U.S. Department of Agriculture’s Rural Development Rural Utilities Service Distance Learning and Telemedicine Grant Program. This funding is meant to empower rural communities by leveraging advanced technology to connect residents and healthcare providers, overcoming the challenges of distance and low population density. Of the total grant, $114,606.80 was allocated to HomeCare & Hospice and Total Senior Care for state-of-the-art digital communication and remote learning tools, including high-definition displays, advanced cameras and integrated audio systems.

3 strategies for hospice GIP compliance Hospice News; by Jim Parker; 10/21/24 Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including ​for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). In a survey earlier this year, more than half of hospice providers reported having undergone multiple types of audits within a six-month period. ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare.

Managing the hospice payment cap by balancing Length of Stay Hospice News; by Jim Parker; 10/15/24 Careful management of the hospice aggregate cap is key to providers’ sustainability as regulatory scrutiny continues to heat up. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. “While the cap is a beneficiary driven cap, meaning the reimbursement allowed per Medicare beneficiary, it is not assessed at the beneficiary level, but rather in the aggregate at the agency provider number level for all beneficiaries served by the agency in the cap,” Rochelle Salinas, vice president of operations for CommonSpirit Health at Home, said. “This allows for greater flexibility in providing care to those in need.” ... [Click on the title's link to continue reading.]

Empath Health established Hurricane Helene Assistance Fund to support colleagues South Florida Hospital and Heaclthcare Report; by Victoria Tanner; 10/6/24 At Empath Health, we believe that caring for our colleagues is just as essential as caring for our patients and families. In response to the recent devastation caused by Hurricane Helene, we have established a special Hurricane Helene Assistance Fund within our Colleague Assistance Fund (CAF) to offer immediate financial relief to colleagues who have been impacted by the storm. This fund is designed to help those facing unexpected expenses, such as temporary housing, home repairs, and other essential needs that have arisen in the wake of the hurricane. By creating this targeted fund, we aim to ensure that our team members can access the resources they need to recover and rebuild during this difficult time. “Our colleagues are the heart of our mission, and in times of crisis, we stand by them just as they stand by our patients,” said Jonathan Fleece, President and CEO of Empath Health. “This fund allows us to help those who give so much to others, ensuring they have the support they need when it matters most.” ... Hurricane Helene, which impacted West Central Florida on [September 26], stands as the most severe storm to hit the region in over a century. Empath Health, with over 3,000 colleagues, serves communities across 20 counties, stretching from Collier County in the south to Marion County in the north. Editor's note: We understand that contributions are made by Empath's colleagues. For other, hospice contributions (especially links where the general public can contribute to hospice staff and/or hospice needs, please contact us via these links, Editor and/or Publisher. Thank you.

Medicare Advantage Value-Based Insurance Design Model Calendar Year 2025 Model Participation CMS Newsroom; Fact Sheet; 9/27/24 The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2025 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. As part of the VBID Model, MA plans offer additional supplemental benefits and/or reduced cost sharing (in some cases to zero). MA plans participating in the VBID Model may also use reward and incentive programs. ... For CY 2025, the VBID Model has 62 participating Medicare Advantage Organizations (MAOs) testing the model in 48 states, D.C., and Puerto Rico through 967 plan benefit packages (PBPs). All 62 participating MAOs prepared Health Equity Plans on how they will address potential inequities and disparities in access, outcomes, and/or enrollee experience of care as it relates to their participation in the VBID Model. 

Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982.