Literature Review

NHPCO: CMS did not account for full burden of implementing HOPE Tool Hospice News; by Jim Parker; 5/29/24 The U.S. Centers for Medicare & Medicaid Services (CMS) may not have accounted for the financial and administrative burdens associated with its implementation of the Hospice Outcomes and Patient Evaluation (HOPE) Tool. In comments on the 2025 proposed hospice rule, the National Hospice and Palliative Care Organization (NHPCO) voiced concerns that the agency’s regulatory impact assessment may not have taken all the details into account, including the need for staffing and technology investments. “Clinical and administrative cost calculations do not align with the reality of the true costs of implementation,” NHPCO indicated in a letter to CMS. “In the proposed rule, CMS significantly underestimated the burden and costs hospices will incur to comply with HOPE requirements. The agency’s estimated cost burden of approximately $185 million across all hospices fails to account for several important factors.”

NHPCO speaks out on 2025 Proposed Medicare Hospice Rates Hospice News; by Jim Parker; 5/28/24 The proposed 2.6% payment increase for hospices is insufficient in today’s economic climate, the National Hospice and Palliative Care Organization (NHPCO) indicated in comments on the 2025 proposed payment rule. ... [Read more for multiple issues addressed.] ... For 2025, the hospice industry group also asked CMS to reconsider the proposed payment rate based on more recent data. ... “It is important to note that hospices, unlike certain other provider types, are at the mercy of these rate updates with no means to address inaccuracies in the market basket forecast. This results in payment rates that are not accurately aligned with the costs faced by hospice providers,” NHPCO indicated. 

The real cost of cancer: 49% of patients carry $5K+ in medical debt Becker's Hospital Review; by Ashleigh Hollowell; 5/28/24 ... Now, 47% of cancer patients accumulate debt as a result of their medical needs, The Wall Street Journal reported May 28. ... Some Americans are facing $38,000 or even more in medical debt, the Journal found. Additionally, more cancer patients are filing for bankruptcy, which one study linked to an 80% increased risk of dying. ... A 2024 survey of 1,284 cancer patients and survivors led by the American Cancer Society Cancer Action Network also found that: ...

21 hospitals, health systems raising workers' pay Becker's Hospital Review; by Kelly Gooch; 5/20/24 The following hospitals and health systems have announced or shared plans for raising workers' pay this year. Note: This is not an exhaustive list. This webpage was last updated May 20. [Click on the title's link for the detailed list.]

Humana, Aetna likely to lose Medicare Advantage members Modern Healthcare; by Nona Tepper and Lauren Berryman; 5/14/24 Industry heavyweights CVS Health Aetna and Humana foresee Medicare Advantage membership losses next year. Anticipated changes to health plan offerings and benefit design to achieve long-term business profitability could mean losing a significant portion of their Medicare Advantage membership, executives told investors at the Bank of America Securities Healthcare Conference on Tuesday. ... Headed into next year, Aetna may adjust benefits, tighten its prior authorization policies, reassess its provider networks and exit markets, CVS Health Chief Financial Officer Tom Cowhey told investors.  ... [Humana Chief Financial Officer Susan Diamond] anticipates losing about 5% of its 6.1 million Medicare Advantage members, ... Conversely, UnitedHealth Group’s UnitedHealthcare insurance business appears to be better positioned for growth heading into 2025 ... , executives said. UnitedHealth Group CEO Andrew Witty said, ... “The thing we don't want is unsustainable ups and downs in our performance in any particular regard. ... You should just expect more of the same from us in terms of what we’re doing.” 

California to redirect more than $7B in healthcare funding Becker's Hospital CFO Report; by Mackenzie Bean; 5/13/24 California is seeking to divert more than $7 billion in funding from the healthcare sector to address a major funding deficit, according to a revised budget proposal released May 10. Gov. Gavin Newsom has proposed reallocating $6.7 billion from Medi-Cal provider rate increases planned for Jan. 1, 2025, to balance the state budget. This funding was generated by the managed care organization tax created last year. ... The proposed budget would also cut funding for healthcare workforce initiatives by $854.6 million through 2028. Funding for public health and various behavioral health programs would also be reduced. 

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.”

Steward files for bankruptcyBecker's Hospital CFO Report; by Laura Dyrda; 5/6/24Dallas, Texas-based Steward Health Care filed for Chapter 11 bankruptcy and will receive millions in financing from Medical Properties Trust to maintain operations at existing hospitals and clinics, according to a May 6 health system news release. The 30 hospitals in the Steward network will continue patient care during the bankruptcy proceedings, and the physician-led health system does not expect interruptions to daily operations. ... The for-profit health system has faced financial challenges and liquidity issues in recent months, blaming low reimbursement from government payers and increasing costs for labor, materials and operations due to inflation. The system also reported continuing to experience negative financial effects from the COVID-19 pandemic.

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. 

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.

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.