Literature Review

800+ California nurses to receive 22.5% pay hike Becker's Hospital Review; by Kelly Gooch; 5/10/24Members of the California Nurses Association have approved a new labor contract with Washington Hospital Healthcare System in Fremont, Calif. The four-year agreement covers roughly 840 nurses, according to a union news release. It was approved by union members May 3 and by the Washington Township Health Care District board of directors May 8. ... According to the CNA, the new deal includes a 22.5% across-the-board increase in wages over four years. It also includes "precedent-setting standard expanding infectious disease protocols and workplace violence protections"; language that protects union members' ability to take meal and rest periods; and protections for part-time positions, according to the union.Editor's Note: These new terms reflect nationwide trends of healthcare/nurse strikes and reasons for leaving their jobs, ie., pay, patient safety, workplace violence, work/home life balance, and more.

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges Times Daily; by Lizzy McClellan Ravitch, The Philadelphia Inquirerer; 5/11/24Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3. In 22 instances that day, the reimbursement was less than the cost of the medication. ... [Managing pharmacist Brad] Tabaac plans to close his doors on May 31 after 26 years in business. ... Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance. The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies.

Treasury extends Medicare insolvency date, citing savings from home health McKnights Home Care; by Adam Healy; 5/13/24 Medicare insolvency received a five-year extension — and part of the reprieve can be attributed to the cost of home health. Myriad factors, including job growth and low unemployment rate, contributed to the extension. The projections were also partly influenced by home health spending which has been “significantly lower than estimated prior to the pandemic,” according to the Social Security and Medicare Trustees report. “As a result of the recent home health staffing shortages, the trustees continue to consider the spending level for this service to be suppressed,” they said in the report. “Thus, they have increased their home health spending growth factor by 2.9 percentage points in each of the next 3 years.”

Medicaid disenrollments higher than expected: Report Becker's Payer Issues; by Rylee Wilson; 5/2/24 The number of people disenrolled from Medicaid through the redeterminations process has surpassed original estimates from the Urban Institute and Robert Wood Johnson Foundation. According to a May 2 report, as of November 2023, nearly 9 million people had been disenrolled from Medicaid. The figure came out to 60.5% of the foundation's original estimate of 14.8 million people losing coverage, with several months remaining in the redetermination process. 

Hospice remains a blind spot for Medicare Advantage Axios; by Maya Goldman; 5/6/24 As Medicare Advantage grows bigger and bigger, there's one area the industry and regulators haven't figured out how to make work yet: hospice. Why it matters: The end-of-life care option is the only Medicare service that can't be offered in the private-run alternative, which now covers over half of enrollees. ... Catch up quick: Usually, when a Medicare Advantage beneficiary decides to enter hospice after receiving a terminal diagnosis, traditional Medicare pays for this care while they remain enrolled in their private plan. ... Editor's Note: This practical, user-friendly article outlines the purposes, challenges, and outcomes of Medicare Advantage with hospice patients. Share this with your leaders and board members.

MultiPlan, insurance giants sued over out-of-network rates Modern Healthcare; by Nona Tepper; 4/29/24 A rural health system sued technology company MultiPlan and eight of the country's largest insurance companies over alleged schemes to strongarm providers into accepting low out-of-network rates. At issue in the proposed class-action suit are MultiPlan's repricing tools, which allegedly rely on insurers' data to deflate their out-of-network reimbursement payments. 

Hospice Claims Edits for Certifying PhysiciansCenters for Medicare & Medicaid Services (CMS); Related CR Release Date 4/18/24; Effective Date: 5/1/24; Implementation Date: 10/7/24Related CR Title: Additional Implementation Edits on Hospice Claims for Hospice Certifying Physician Medicare EnrollmentStarting May 1, 2024, we’ll deny hospice claims if the certifying physician, including hospice physician and hospice attending physician, isn’t on our PECOS hospice ordering and referring files. This addresses hospice program integrity and quality of care per Section 6405 of the Affordable Care Act.

OSF launches new tools to help make end-of-life planning easier News25, Peoria, IL; by Liz Lape; 4/26/24 OSF Healthcare reports that thousands of patients are dying in medical facilities without end-of-life care plans. ... Sarah Overton, Chief Officer of Nursing, describes that studies show that over 70% of patients would prefer a setting other than a hospital to spend their last moments, like at home hospice or palliative care. OSF has launched self-service resources such as an Advanced Careplanning page and Patient Questionnaire on their app MyChart. Overton says the goal is to make end-of-life care planning more available to the public.

Drug discount program is exploiting poor patients while corporate giants profit Minnesota Reformer; by David Balto; 4/26/24 ... The federal 340B drug discount program was created three decades ago to help economically vulnerable Americans access affordable prescription medications and providers in underserved areas expand and improve services. Under the program, drug companies participating in Medicaid — known in Minnesota as Medical Assistance — provide sizeable discounts as high as 50% to these ‘safety net’ health care facilities. ... Unfortunately, over time, the tens of billions of dollars flowing through this program have proven irresistible to for-profit corporate entities, including giant health systems and big box chain pharmacies — and there is no guarantee those discounts are reaching patients. 

Payment cuts are having a compounding, dire effect on the home health industry Home Health Care News; by Andrew Donlan; 4/25/24 Home health providers’ fight against cuts to fee-for-service Medicare payment has become a year-by-year battle. But the yearly cuts are compounding, which is exactly what industry advocates are trying to illustrate to Congress prior to the next payment rule proposal. ... Many of the cuts CMS has implemented are permanent, and multiple cuts on top of each other moving forward – plus unsatisfactory adjustments for inflation – are putting significant pressure on providers.

Getting your claims denied? Here are reasons why and what you can do about itMedial Economics; by Gretchen Heinen, RN, PHN, BSN and Wael Khouli, MD, MBA; 4/25/24A recent voluntary, national survey by Premier shed new light on denied claims. The survey, conducted from October to December 2023, revealed that nearly 15% of all claims across Medicare Advantage, Medicaid, Commercial, and Managed Medicaid are denied. Of those denied claims, 45% to 60% were overturned, albeit with a costly appeal process sometimes involving multiple appeals. ... With a skillfully crafted appeal letter, a denial can be overturned 50% to 70% of the time. In this article, we will cover denial basics, reasons for claim denials, and actions to take. It is crucial to address all potential reasons for claim denial, including: ...

How the FTC noncompete ban affects nonprofit providers Modern Healthcare; by Alex Kacik; 4/25/24 The Federal Trade Commission’s ban on noncompete agreements will apply to some healthcare nonprofits, lawyers said. ... In the final rule, the FTC offers an example of a nonprofit hospital that employed 100 physicians. The commission would have jurisdiction “because the organization engaged in business on behalf of for-profit physician members,” the rule states. ... The FTC created a carve-out for senior executives in the final rule. Existing noncompete agreements with senior executives, defined as workers who earn more than $151,164 a year and are in policymaking positions, can remain in place. But employers are barred from enforcing new noncompete provisions with senior executives.

Commercial Capital Connect unveils $25M financing for home health care & hospice agencies nationwide – revolving credit lines & term loans up to $750K Consumer Infoline; 4/25/24Commercial Capital Connect, a leading marketplace for commercial finance solutions, today announced the launch of a $25 million financing program to provide revolving lines of credit and term loans to home health care and hospice agencies across the United States. ... “The home health care and hospice sectors play a vital role in our communities, providing essential services that enable people to receive quality care in the comfort of their homes,” said Cheryl Tibbs, President of Commercial Capital Connect.