Literature Review

Dane County Board approves funding for hospice care program for homeless individualsABC TV 27 WKOW, Madison, WI; by Chloe Morrissey; 4/6/24Multiple organizations aiming to combat homelessness received approval for funding after Thursday night's Dane County Board meeting. One organization, Solace Friends, will be receiving $100,000 for the creation of Solace Home. It's a hospice program for housing insecure individuals given less than 6 months to live. The home can serve up to four people at one time who are currently living on the street, in a shelter or an unstable housing situation. 

CMS: Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F)CMS, Medicare Part D, Policy; 4/4/24On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. Additionally, this final rule addresses several key provisions that remain from the CY 2024 Medicare Advantage and Part D proposed rule, CMS-4201-P, published on December 14, 2022. ... This fact sheet discusses the major provisions of the 2025 final rule which can be downloaded here: https://www.federalregister.gov/public-inspection/2024-07105/medicare-program-medicare-advantage-and-the-medicare-prescription-drug-benefit-program-for-contract

Medicare Program; FY 2025 Hospice Wage Index and Payment Rate Update, Hospice Conditions of Participation Updates, and Hospice Quality Reporting Program Requirements Federal Register; A Proposed Rule by the Centers for Medicare & Medicaid Services on 4/4/24This document has a comment period that ends in 53 days, 5/28/24.This proposed rule would update the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year (FY) 2025. This rule proposes changes to the Hospice Quality Reporting Program. This rule also proposes to adopt the most recent Office of Management and Budget statistical area delineations, which would change the hospice wage index. This rule proposes to clarify current policy related to the “election statement” and the “notice of election”, as well as to add clarifying language regarding hospice certification. Finally, this rulemaking solicits comments regarding potential implementation of a separate payment mechanism to account for high intensity palliative care services.

Hospice update: March goes out like a lion Morgan Lewis - Health Law Scan, by Howard J. Young; 4/2/24 The old adage—March comes in like a lion and goes out like a lamb—didn’t quite hold true for the hospice sector, which experienced a late-month flurry of activity. The government gave the hospice sector a lot to consider, from MedPAC’s suggested freeze on hospice rates to CMS’s 2025 Proposed Hospice Rule (public comments due May 28, 2024) that, if finalized as is, would include a 2.6% payment bump. CMS’s Proposed Hospice Rule lays the groundwork for the long-anticipated Hospice Outcomes and Patient Evaluation (HOPE) quality measures data collection instrument, which will be used to collect data at various points during the hospice stay, not just at admission and discharge.  

Nursa Survey finds 98% of hospital CFOs view nurse staffing as top challenge Morningstar, provided by Business Wire; 4/2/24Survey results offer insight into C-suite perspectives on workforce trends and financial impact. Nursa, a nationwide platform that exists to put a nurse at the bedside of every patient in need, today released the results of a survey with healthcare decision-makers that examines their perspectives on the evolving social contract of employment, opinions on the 1099 workforce, and reflections on what makes a nurse truly valuable to an organization. Key findings from the survey include:

Glendale, California men sentenced for role in $9M hospice fraud scheme – owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc.Sierra Sun Times; 3/31/24The owner of two California-based hospice companies, along with his biller and consultant, were sentenced last Thursday for their respective roles in a scheme that resulted in stealing over $9 million from Medicare in false and fraudulent claims for hospice services. ... According to court documents, ...  [Gayk] Akhsharumov concealed his ownership and control over the hospice entities from Medicare, inserted nominee owners, paid kickbacks to patient recruiters, and profited from the scheme. In April 2020, after San Gabriel had ceased operations, Akhsharumov used the company to fraudulently obtain COVID-19 relief funds.

How’s Your Soul? JAMA Network, by Daivd Vermette, MD, MBA, MHS; 3/28/24 "Brother David, how’s your soul?” The question took me by surprise. It was time for my first advisement meeting with my residency program director. In medicine, the machine runs on competence and achievement of “milestones.” Yet, as I braced for a meeting to trudge through performance evaluations and in-training exam scores, I awoke to humanity. ... Medical education has numerous models for coaching, advising, and mentoring. While these models helped develop my professional life, they missed the fundamental core of who I am: a human being. Perhaps instead we could embrace a model in medical education built on the tenets of pastoral care. ...

How sales and marketing compensation can get hospices into hot waterHospice News, by Holly Vossel; 3/27/24Regulators are taking a closer look at how hospices pay their marketing and outreach workforces to curb fraudulent activity tied to referral streams. Federal and state regulatory agencies have systems in place to detect fraud, waste and abuse in hospice, and some are honing on oversight of sales, marketing and outreach staff payment arrangements, according to Ellen Persons, shareholder at Polsinelli Law Firm. 

Medicare, Medicaid made $100B in improper payments in 2023 Becker's Hospital Review - Legal & Regulatory Issues, by Andrew Cass; 3/27/24 The federal government reported an estimated $235.8 billion in improper payments in fiscal year 2023, with more than $100 billion coming from Medicare and Medicaid, according to a March 26 report from the U.S. Government Accountability Office. The $235.8 billion in improper payments reported by 14 agencies across 71 programs is a decrease from the $247 billion reported in 2022, but the figure remains higher than pre-pandemic levels, according to the report. 

Nearly half of health systems are considering dropping Medicare Advantage plans Becker's Hospital CFO Report, by Andrew Cass; 3/22/24 ... "HFMA Health System CFO Pain Points Study 2024" is based on a survey of 135 health system CFOs conducted in January.  According to the report, 16% of health systems are planning to stop accepting one or more Medicare Advantage plans in the next two years. Another 45% said they are considering the same but have not made a final decision. 

Is cybersecurity spending too low to prevent another Change breach? Modern Healthcare, by Brock E.W. Turner; 3/19/24 On Feb. 21, Change Healthcare, which processes 15 billion transactions a year, suffered a ransomware attack that has caused ripple effects throughout the healthcare system, hampering operations and finances for hospitals, physician offices, pharmacies, insurers and patients. Cybersecurity professionals are sounding the alarm on future attacks if healthcare organizations don't start putting more financial resources into protecting their data. 

Care coordination, quality data crucial to hospice referral growthHospice News, by Holly Vossel; 3/18/24Care coordination and quality data will be engines for hospice referral growth. Hospices saw census volumes drop during the COVID-19 public health emergency as facilities nationwide restricted access to patients amid mandated state closures. Providers often turned to electronic communications to reach patients in facility- and community-based settings alike. Adaptability has been among the keys to coping with the pandemic’s lingering punches in referral streams, according to Craig Dresang, CEO of California-based YoloCares. As end-of-life care received a spotlight during a global pandemic, the historical viewpoints around hospice care delivery have been undergoing a “fundamental shift,” Dresang said.