Literature Review

The Wall Street Journal: Exclusive: Cigna nears deal to offload Medicare businessThe Wall Street Journal, by Laura Cooper, Anna Wilde Mathews and Lauren Thomas; 1/3/24Cigna is in advanced talks to sell its Medicare business in an about-face for the health-insurance giant, which had been expanding its footprint in the fast-growing sector. Cigna, which has been running an auction for the business, known as Medicare Advantage, is now in exclusive talks to sell it to Health Care Service Corp. for between $3 billion and $4 billion, according to people familiar with the matter. Editor's Note: Access to the full article requires a subscription to The Wall Street Journal

The future of claims management: How payers can maximize payment integrityBecker's Payer Issues; 12/29/237 to 10 cents of every dollar spent on healthcare goes toward paying for fraudulent claims. Learn the latest strategies for boosting payment integrity here.

Hospital merger activity to increase in 2024Modern HealthcareDecember 26, 2023Hospital merger and acquisition activity is expected to increase next year as hospitals manage financial pressure, competitors combine and insurers grow. ... The number of announced hospital deals through the third quarter rose by more than 50%, to 53 proposed transactions from 35 last year, according to data from consultancy Kaufman Hall. Deal activity was particularly pronounced among midsized health systems ranging from $1 billion to $5 billion in annual revenue. ... Nearly 40% of the 18 proposed hospital deals announced in the third quarter were driven by financial distress, according to Kaufman Hall. 

After the chaotic closure of a St. Louis nursing home, will others also shut down?St. Louis Post-DispatchDecember 24, 2023St. Louis, MO—The north St. Louis nursing home that closed abruptly last weekend, setting off a chaotic relocation of residents and layoffs of workers without warning, had been in decline for several years. ... Other area nursing homes face similar financial pressures and lingering damage from the COVID-19 pandemic. ... “I think we’re going to see a lot of nursing homes close, that’s my prediction—I mean a lot of nursing homes,” [Harvey] Tettlebaum [a lawyer who for decades has represented the Missouri Healthcare Association, a group for long-term health care organizations] said. “I think it’s going to escalate next year.” Among the most vulnerable are providers that primarily serve residents who rely on Medicaid. 

Despite Economic Growth in 2023, State of the Commonwealth Report Shows Worrying TrendsNews ReleaseDecember 18, 2023Norfolk, VA—There are positive takeaways from Old Dominion University’s ninth annual State of the Commonwealth Report. Virginia’s economy and population continued to grow in 2023 and a record number of people were employed and in the labor force, surpassing pre-pandemic levels. But the report, produced by ODU’s Dragas Center for Economic Analysis and Policy, also raises questions about the commonwealth’s future. 

‘Tougher Every Day’—Nursing Home Operators, CCRCs Weigh in on Future of Skilled NursingSkilled Nursing NewsDecember 14, 2023Operating a skilled nursing facility today is considered a “tough business” with regulations and reimbursement woes making the space “tougher every day.” Other operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. 

Board hears comment on noise ordinance, EPH home healthcareEstes Park (CO) Trail GazetteDecember 14, 2023Estes Park, CO—The Estes Park Board of Trustees held their regular meeting on Tuesday, Dec. 12, where they heard ... [an] update from Estes Park Health about home health care, hospice and non-medical home care. ... EPH Board of Directors Chairman David Batey described the hospital’s decision to no longer provide in-home hospice care, highlighting that there are four licensed providers of hospice care other than EPH, and that EPH will continue to provide inpatient hospice care at the facility. 

Telehealth use among seniors back up to pandemic-era highs, one company claimsMcKnight’s Senior LivingDecember 13, 2023Nearly all seniors in the US, an astonishing 97%, had at least one telehealth appointment this year, a new survey indicates. The data, which comes from remote platform operator Independa, indicates that telehealth usage among seniors has grown 20% over the past three years, nearly back up to the pandemic-era peak, when in-person options were not available. 

Home Health Spending Begins To Climb Again Post-PandemicHome Health Care NewsDecember 13, 2023After stalling in 2021, spending on home health care returned to a more normalized growth rate in 2022, according to a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services. Specifically, national health expenditures on home health care increased by 6% to $132.9 billion in 2022. 

Home Health Industry Leaders Scoff At ‘Distorted Picture of Reality’ Painted By MedPACHome Health Care NewsDecember 12, 2023The Medicare Payment Advisory Commission recommended that the Medicare base payment rate for home health care be reduced by 7% for CY 2025. The recommendation is another chapter in the contentious relationship between the commission and the home health industry. It also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Operating in the redPuget Sound Business Journal (Seattle, WA)December 10, 2023... Across Washington, health systems representing 93% of the state’s beds have incurred more than $750 million in operational losses in the first half of 2023, according to data from the Washington State Hospital Association. ... Those losses were much steeper in 2022, but a majority of Washington hospitals are still operating at a deficit, burning through cash reserves to keep their doors open. Statewide, 17 hospitals have less than three months of operating costs in their reserves, per WSHA. ... “Folks have probably heard the term ‘no margin, no mission.’ So, no matter how foundational your mission statement is, if you don’t have the finances to run the organization, then there really can’t be a mission for you,” [EvergreenHealth Chief Medical and Quality Officer Dr. Ettorre] Palazzo said. ... As hospitals look for ways to stave off financial losses, they’re faced with another crisis—a population that is demonstrably sicker than it was prior to Covid 19. That’s leading to high hospital censuses and clogged emergency departments, further stressing hospital systems, employee well-being and financial viability.

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025.