Literature Review

CMS finalizes 2.9% cut in physician payments for 2025, including for palliative care Hospice News; by Jim Parker; 11/4/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized a nearly 2.9% cut for 2025 in physician payment rates used to reimburse palliative care care practitioners, among other professionals. The final rule also states that the telehealth flexibilities implemented during the COVID-19 public health emergency will expire at the end of this year unless Congress intervenes. Physicians and other professionals will have to follow pre-COVID restrictions on telehealth, with few exceptions. Industry organizations were quick to denounce the pay cut. “To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” American Medical Association President Dr. Bruce Scott said in a statement.

Medicare Part D paid millions for drugs for which payment was available under the Medicare Part A Skilled Nursing Facility Benefit HHS Office of Inspector General; Report Highlights; 10/27/24 What OIG Found: ... On the basis of our sample results, for 2018 through 2020, we estimated that up to the entire Part D total cost of $465.1 million was improperly paid for drugs for which payment was available under the Part A SNF benefit. Of that amount, we estimated that approximately $245.4 million was for drugs that the medical records showed were administered to Part D enrollees during their Part A SNF stays.What OIG Recommends: We made five recommendations, including that CMS work with its plan sponsors to adjust or delete PDEs, as necessary, and determine the impact to the Federal Government related to the Part D total costs of $953,370 for drugs associated with our sample items for which payment was available under the Part A SNF benefit; work with its plan sponsors to identify similar instances of noncompliance that occurred during our audit period and determine the impact to the Federal Government, which could have amounted up to an estimated $465.1 million in Part D total cost; and provide plan sponsors with timely and accurate information, such as dates of covered Part A SNF stays, to reduce instances of inappropriate Part D payment for drugs for which payment is available under the Part A SNF benefit. ... CMS concurred with all five recommendations.

Southern Tier Health helps HomeCare & Hospice, Total Senior Care on USDA grant Olean Times Herald, Olean, NY; by Kellen M. Quigley; 10/22/24 A collaboration between three local agencies looking out for the health and well-being of their clients is getting a modern technological boost thanks to a federal grant. The Southern Tier Health Care System, Inc. (STHCS) was recently awarded nearly $140,000 through the U.S. Department of Agriculture’s Rural Development Rural Utilities Service Distance Learning and Telemedicine Grant Program. This funding is meant to empower rural communities by leveraging advanced technology to connect residents and healthcare providers, overcoming the challenges of distance and low population density. Of the total grant, $114,606.80 was allocated to HomeCare & Hospice and Total Senior Care for state-of-the-art digital communication and remote learning tools, including high-definition displays, advanced cameras and integrated audio systems.

3 strategies for hospice GIP compliance Hospice News; by Jim Parker; 10/21/24 Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including ​for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). In a survey earlier this year, more than half of hospice providers reported having undergone multiple types of audits within a six-month period. ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare.

Managing the hospice payment cap by balancing Length of Stay Hospice News; by Jim Parker; 10/15/24 Careful management of the hospice aggregate cap is key to providers’ sustainability as regulatory scrutiny continues to heat up. The cap is designed to prevent overuse of hospice, put controls on Medicare spending and foster greater access to care among patients. For Fiscal Year 2024, the U.S. Centers for Medicare & Medicaid Services set the cap at $33,394. In 2025, this will rise to $34,465. “While the cap is a beneficiary driven cap, meaning the reimbursement allowed per Medicare beneficiary, it is not assessed at the beneficiary level, but rather in the aggregate at the agency provider number level for all beneficiaries served by the agency in the cap,” Rochelle Salinas, vice president of operations for CommonSpirit Health at Home, said. “This allows for greater flexibility in providing care to those in need.” ... [Click on the title's link to continue reading.]

Empath Health established Hurricane Helene Assistance Fund to support colleagues South Florida Hospital and Heaclthcare Report; by Victoria Tanner; 10/6/24 At Empath Health, we believe that caring for our colleagues is just as essential as caring for our patients and families. In response to the recent devastation caused by Hurricane Helene, we have established a special Hurricane Helene Assistance Fund within our Colleague Assistance Fund (CAF) to offer immediate financial relief to colleagues who have been impacted by the storm. This fund is designed to help those facing unexpected expenses, such as temporary housing, home repairs, and other essential needs that have arisen in the wake of the hurricane. By creating this targeted fund, we aim to ensure that our team members can access the resources they need to recover and rebuild during this difficult time. “Our colleagues are the heart of our mission, and in times of crisis, we stand by them just as they stand by our patients,” said Jonathan Fleece, President and CEO of Empath Health. “This fund allows us to help those who give so much to others, ensuring they have the support they need when it matters most.” ... Hurricane Helene, which impacted West Central Florida on [September 26], stands as the most severe storm to hit the region in over a century. Empath Health, with over 3,000 colleagues, serves communities across 20 counties, stretching from Collier County in the south to Marion County in the north. Editor's note: We understand that contributions are made by Empath's colleagues. For other, hospice contributions (especially links where the general public can contribute to hospice staff and/or hospice needs, please contact us via these links, Editor and/or Publisher. Thank you.

Medicare Advantage Value-Based Insurance Design Model Calendar Year 2025 Model Participation CMS Newsroom; Fact Sheet; 9/27/24 The Centers for Medicare & Medicaid Services (CMS) is announcing the Calendar Year (CY) 2025 participants in the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. As part of the VBID Model, MA plans offer additional supplemental benefits and/or reduced cost sharing (in some cases to zero). MA plans participating in the VBID Model may also use reward and incentive programs. ... For CY 2025, the VBID Model has 62 participating Medicare Advantage Organizations (MAOs) testing the model in 48 states, D.C., and Puerto Rico through 967 plan benefit packages (PBPs). All 62 participating MAOs prepared Health Equity Plans on how they will address potential inequities and disparities in access, outcomes, and/or enrollee experience of care as it relates to their participation in the VBID Model. 

Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982. 

BREAKING NEWS: 9/27/2024 11:45 am - Blumenauer proposes overhaul to Hospice Benefit: If enacted, the legislation would be the single most significant update to the hospice benefit and payment structure since its inception in 1982.

HopeHealth CMO: Hospice rules for ‘unrelated care’ getting stricter Hospice News; by Jim Parker; 9/25/24 Dr. Ed Martin began working in hospice in 1987 after hearing families talk about their experiences with those services. Today, he is chief medical officer of Rhode Island-based HopeHealth. The more than 50-year-old nonprofit organization also serves parts of Massachusetts. Martin recently spoke about the complicated issue of care that is deemed “unrelated” to a patient’s terminal diagnosis at the National Hospice and Palliative Care Organization’s Annual Leadership Conference in Denver. Hospice News sat down with Martin at the conference to discuss how he and his organization are addressing the matter of unrelated care, as well as the efficacy of requirements for an addendum to the election statement. [Click on the title's link to continue reading this interview.]

Blue Ridge Hospice Thrift Shop reaches $1M milestone LoudonNow.com, Leesburg, VA; by Staff Report; 9/17/24 Blue Ridge Hospice Thrift Shop in Purcellville surpassed $1 million in sales this year, a threshold of success the organization attributes to unwavering community support. Money raised at the Main Street store supports its efforts to provide quality and compassionate care for those facing serious illness and end-of-life challenges. “Our thrift shops serve as windows into the living rooms of our community. They reflect the spirit of giving and caring that defines Loudoun County. Reaching the $1 million mark is not just a financial achievement that supports our purpose and mission-driven work; it’s a testament to the collective effort of a community that truly values and supports its neighbors,” President and CEO Jason Parsons stated.

More home health providers sunset relationships with largest Medicare Advantage players Home Health Care News; by Andrew Donlan; 9/13/24 Essentia Health--a regional nonprofit health system with a substantial home health arm--announced this week that it will no longer serve as an in-network provider for UnitedHealth Group. ... Dr. Cathy Cantor, Essentia’s chief medical officer for population health, said in a statement ... “The frequent denials and associated delays negatively impact our ability to provide the timely and appropriate care our patients deserve. This is the right thing to do for the people we are honored to serve.” Headquartered in Duluth [MN], Essentia Health provides care across Minnesota, Wisconsin and North Dakota. Its network includes about 15,000 employees, 14 hospitals, 78 clinics, six long-term care facilities, six assisted living and independent living facilities, and much more. It also has a robust home health and hospice business. The company has informed patients that it will no longer serve as an in-network provider for the above-mentioned MA payers beginning Jan. 1. ... Sanford Health, a health system based in Sioux Falls, South Dakota, announced a similar plan this week. 

Humana to depart 13 Medicare Advantage markets Modern Healthcare; by Lauren Berryman; 9/4/24 Humana previewed its Medicare Advantage strategy for the coming plan year, including a decision to quit 13 counties where performance has been unsatisfactory, at the Wells Fargo Healthcare Conference on Wednesday. The Medicare Advantage heavyweight, which had 6.2 million members in those plans as of the second quarter, expects to lose a few hundred thousand enrollees in 2025 as it prioritizes profitable markets, Chief Financial Officer Susan Diamond told investors at the event in Everett, Massachusetts. In addition to leaving those 13 counties, Humana will offer fewer plans in some other areas, Diamond said. About 560,000 members will have to choose new policies for 2025, most of whom will have other Humana plans available to them, she said. ... Diamond did not specify what markets will be affected, but Humana will continue selling Medicare Advantage plans in every state. The company is committed to a presence in certain favorable regions, including south Florida, she said.