Literature Review

Hospice market surge: Expected to hit $182.1 billion by 2033 Market.us Media; by Trishita Deb; 7/29/24 The global hospice market is projected to grow significantly from USD 72.8 billion in 2023 to around USD 182.1 billion by 2033, achieving a CAGR of 9.6%. This expansion is primarily driven by an aging population requiring increased palliative and end-of-life care. The demographic shift necessitates services that address chronic illnesses and provide compassionate care, predominantly offered by hospices. Additionally, technological advancements, particularly in telemedicine, facilitate broader access to comprehensive care, especially in remote areas. Interdisciplinary approaches in palliative care are also pivotal, involving collaborative efforts from doctors, nurses, social workers, and chaplains. This holistic method not only enhances the quality of care but also boosts patient and family satisfaction, key metrics in healthcare evaluations. 

Readers write: Why RCM is the most interesting opportunity in healthcare HIStalk - Healthcare IT News & Opinion; by Kim Waters, MBA; 7/22/24 Revenue cycle management (RCM) isn’t for everybody, but it certainly is for me. ... In a 2023 study, HFMA reported on the rising cost of claims, with as much as 60% of claims not resubmitted and the average denial rate’s total percentage of gross revenue at 11%. What’s more is that they found that the cost per claim appealed is $118 and the denial rate is increasing 20% year over year. In an era when budgets are tight and margins are lower, organizations need to improve on these numbers to survive and eventually thrive. Opportunities for improvement can be easy to see. Reconsider any processes or solutions that:

7 arrested in Arizona on hospice, behavioral health fraud charges Hospice News; by Jim Parker; 7/19/24 Seven individuals in Arizona face federal charges for their alleged roles in defrauding Medicare out of hundreds of millions of dollars in total. The charges for the most part stem from submitting Medicare claims for patients who were not eligible for hospice care, as well as fraud related to behavioral health services. The arrests were the result of a two-week nationwide federal law enforcement action that resulted in criminal charges for 193 individuals for a total of more than $2.75 billion in alleged false claims, as well as opioid abuse schemes. ... “These cases involve not just massive fraud to steal public funds, but also exploitation of vulnerable victims and the misappropriation of resources earmarked for Native American communities,” said U.S. Attorney Restaino, in a statement. “The U.S. Attorney’s Office and our investigative partners will pursue justice against those who perpetrate these sorts of schemes with the utmost vigor.”

Navigating Aging: Lack of affordability tops older americans’ list of health care worries KFF Health News - Northern Kentucky Tribune; by Judith Graham, KFF News; 7/5/24 What weighs most heavily on older adults’ minds when it comes to health care? The cost of services and therapies, and their ability to pay. ... A new wave of research highlights the reach of these anxieties. When the University of Michigan’s National Poll on Healthy Aging asked people 50 and older about 26 health-related issues, their top three areas of concern had to do with costs: of medical care in general, of long-term care, and of prescription drugs. More than half of 3,300 people surveyed in February and March reported being “very concerned” about these issues. 

10 key Medicare Advantage updates in 2024 Becker's Payer Issues; by Rylee Wilson; 6/27/24 The first half of 2024 brought shifting trends for Medicare Advantage. Payers continued to warn of rising medical costs in the MA population, and some are predicting they will lose members next year. Insurers picked up a win in June when CMS said it would recalculate star ratings for 2024. Here are 10 key Medicare Advantage updates to know: 

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.