Literature Review

A wave of change is coming for healthcare benefits — are hospitals ready? Becker's Hospital CFO Report; by Jakob Emerson; 9/3/24Surveys of employers are making one thing clear: Healthcare costs are rising faster than they did before the pandemic, and those costs are being driven by inflation, the increasing use of weight loss medications, and higher overall medical expenses.  ... As financial pressures mount, many employers are exploring or expanding alternative payment and coverage models, a trend that could significantly alter hospital's revenue streams. ...  The average cost of employer-sponsored coverage is expected to jump 9% from 2024 to 2025, according to estimates from Aon published in August. Healthcare costs per employee are projected to surpass $16,000 per employee in 2025, driven by rising employment levels, inflation and rising pharmaceutical costs. In 2024, employers budgeted an average of $14,823 per employee for healthcare costs. These costs have risen by more than 20% over the past five years and by 43% over the past decade.

Seven-year-old finishes 145-mile charity challenge BBC News, Northamptonshire, United Kingdom; by Brian Farmer; 9/2/24 A seven-year-old boy has raised more than £600 for charity after walking, cycling and scooting 145 miles over four months. Isaac Yates, from King's Cliffe, Northamptonshire, got into the habit of exercising on 1 May and completed his 145-mile (233km) challenge, in aid of the Sue Ryder Thorpe Hall Hospice in Peterborough, on 1 September. He has helped walk family dogs Poppy and Summer, ridden his bike, and scooted his scooter until the mileage totted up to his 145 target. The youngster added to the fun by logging his trips on an online Lord of the Rings game - which enabled him to take a virtual 145-mile journey through writer J. R. R. Tolkien's fictional Middle Earth with two Hobbits.Editor's Note: Pair this with today's article, Crisis in care for dying people says Marie Curie as survey shows suffering. 

Hospice’s post-VBID value-based outlook Hospice News; by Holly Vossel; 8/15/24 The post-Medicare Advantage hospice carve-in landscape could include wider value-based reimbursement avenues in the hospice space, leading providers to pivot into MA payer relationships. The forthcoming end of the hospice component of the value-based insurance design (VBID) demonstrative takes effect Dec. 31. Launched in 2021, the carve-in was designed to test coverage of hospice care through Medicare Advantage, as well as coverage of palliative and transitional care. Hospices will need a strong value-based payment negotiation strategy to prepare for the unknowns that lie ahead, according to Melinda Gaboury, co-owner and CEO of Healthcare Provider Solutions Inc., a hospice and home care consulting company. 

Biden administration says Medicare negotiated price discounts on 10 prescription drugs USA Today; by Ken Alltucker; 8/15/24 ... The Biden administration announced Thursday that Medicare had negotiated discounts with pharmaceutical companies on 10 drugs prescribed to treat blood clots, cancer, heart disease and diabetes. The drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the insulins Fiasp and NovoLog. The discounts will range from 38% to 79% when the negotiated prices take effect in 2026. The bargaining will save Medicare $6 billion when the price cuts are implemented in two years, according to U.S. Department of Health and Human Services estimates. 

Inside one hospice’s battle for survival as it faces ‘incoming tsunami’ of need SwiftTeleca in South Boston, Virginia, with this article about Swindon, United Kingdom; by Shawn Butlere; 8/13/24Swindon’s Prospect Hospice is facing a £1million deficit this year. Hospices are receiving “woefully inadequate” funding to deal with an “incoming tsunami” of patients needing end-of-life care, a desperate sector leader has warned. ... Chief executive Jeremy Lune ... said: “Hospice funding is woefully inadequate at the moment – that is a fact. In the last 10 years, the amount that we receive from the NHS has not increased in real terms at all. “The cost of living crisis and so on mean that in real terms, it has decreased. And the need for hospice services is increasing. With an ageing population, people are living longer, they’re living with more conditions, and the funding simply doesn’t reflect that.”Editor's Note: USA hospice leaders, what themes and potential threats to our hospices are you seeing, especially in light of the new CMS Hospice Final Rule?

Letter: Closing Cottage of the Meadow [Hospice House] is a loss for allYakima Herald-Republic, Yakima, WA; by Lee Murdock; 8/13/24, with news post from 8/5/24 [Letter] To the editor — I was devastated to learn that Cottage in the Meadow, our local hospice facility, is ending hospice care. Both of my parents were fortunate enough to spend their final days in this serene and caring environment. The difference between the overrun hospital setting with its short staffing and the compassionate, individualized care at Cottage in the Meadow was stark. This facility provided invaluable support not only to those at the end of life but also to their families. As our population ages, the need for such services will only increase. Studies have shown that hospice care can reduce healthcare costs by up to 30% compared to traditional hospital care (Journal of Palliative Medicine). Additionally, hospice care significantly reduces hospital readmissions and emergency room visits, further reducing healthcare costs (JAMA). In a healthcare system with ample profit margins, ensuring access to hospice care is the least we can do. ...Editor's Note: This letter to the editor was in response to Yakima Herald-Republic's 8/5/24 article, "Yakima's Cottage in the Meadow will close its hospice house. It will reopen as a skilled nursing facility."

Hospices face ‘hard roads’ in budgeting for sustainable growthHospice News; by Holly Vossel; 8/9/24Hospice budgeting practices hinge on several factors, according to Matt Chadwick, CFO of Well Care Health. Building a sustainable financial structure for end-of-life care delivery can be a challenging feat when navigating the impacts of patient care and staffing needs, referral streams, operational expenses, billing claim cycles and compliance factors, Chadwick said... Quality and compliance are also important pieces of a hospices’ budget and growth potential as providers experience. Case in point, hospices that fail to comply with new quality reporting requirements set forth in the 2025 payment rule face a 4% penalty... “The budget should not just be solely 100% of the financial person’s responsibility,” Rachael Feeback, revenue cycle senior product manager of home and hospice at MatrixCare by ResMed, said. “It should be a conversation with the clinical side, the operational side, so that you’re understanding your different measurements for hospice and how that translates to the budget and not solely focused on the pure dollars behind it.”

[CMS Fact Sheet] Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule (CMS-1810-F) CMS Fact Sheet - Final Rule (CMS-1810-F); 7/30/24 On July 30, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1810-F) updating Medicare hospice payment rates and the aggregate cap amount, for fiscal year (FY) 2025, in accordance with existing statutory and regulatory requirements. This rule also finalizes the proposal to adopt the most recent Office of Management and Budget (OMB) statistical area delineations, which impacts the hospice wage index and clarifies current policy related to the hospice “election statement” and the “notice of election” (NOE), as well as adds clarifying language regarding hospice admission and certification of terminal illness. The final rule summarizes public comments received related to the request for information regarding implementing a separate payment mechanism to account for high-intensity palliative care services. Editor's Note: Click here for the full Final Rule. 

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:

How well does Medicare cover end-of-life care? It depends on what type Medical Xpress; by Mark Harden, CU Anschutz Medical Campus; 7/19/24 Not all versions of Medicare are created equal—and when it comes to end-of-life care, some versions may serve a patient's needs better than others. That's the focus of newly published research by Lauren Hersch Nicholas, Ph.D., MPP, a University of Colorado Department of Medicine and CU Cancer Center health economist, and her colleagues. The researchers analyzed the experiences of more than a million people receiving Medicare-funded services in the last six months of their lives. ... Their paper was published July 19 in JAMA Health Forum. What Nicholas and her colleagues found is that the kind of Medicare a patient is enrolled in can make a difference in whether that patient gets certain treatments, and whether the patient dies in a hospital or in hospice care.

Streamlining financial processes in end-of-life care: The crucial role of revenue cycle management for hospices United Business Journal - UBJ; by Rahul Kumar; 7/16/24In the increasingly complex healthcare landscape, hospices face unique challenges in managing their financial processes. One crucial aspect that significantly impacts their efficiency and sustainability is Revenue Cycle Management (RCM) for hospices. This blog post aims to shed light on the essential role of RCM for hospices in streamlining financial operations, ensuring they can continue to provide compassionate and high-quality end-of-life care.

Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. Federal Register; Proposed Rule by the Centers for Medicare & Medicaid Services; 7/5/24

States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model CMS.gov; 7/2/24 On July 2, 2024 CMS announced that Connecticut, Maryland, and Vermont will be the first state participants in the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Hawaii will also participate, pending satisfaction of certain requirements. Applications to participate in Cohort 3 of the model are due August 12, 2024 at 3:00 p.m. EST (Cohort 3). Eligibility requirements and additional model details can be found in the NOFO.  To stay up to date on model announcements, events, and resources, please sign up for the AHEAD Model listserv.