Literature Review

‘Tougher Every Day’—Nursing Home Operators, CCRCs Weigh in on Future of Skilled NursingSkilled Nursing NewsDecember 14, 2023Operating a skilled nursing facility today is considered a “tough business” with regulations and reimbursement woes making the space “tougher every day.” Other operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. 

Board hears comment on noise ordinance, EPH home healthcareEstes Park (CO) Trail GazetteDecember 14, 2023Estes Park, CO—The Estes Park Board of Trustees held their regular meeting on Tuesday, Dec. 12, where they heard ... [an] update from Estes Park Health about home health care, hospice and non-medical home care. ... EPH Board of Directors Chairman David Batey described the hospital’s decision to no longer provide in-home hospice care, highlighting that there are four licensed providers of hospice care other than EPH, and that EPH will continue to provide inpatient hospice care at the facility. 

Telehealth use among seniors back up to pandemic-era highs, one company claimsMcKnight’s Senior LivingDecember 13, 2023Nearly all seniors in the US, an astonishing 97%, had at least one telehealth appointment this year, a new survey indicates. The data, which comes from remote platform operator Independa, indicates that telehealth usage among seniors has grown 20% over the past three years, nearly back up to the pandemic-era peak, when in-person options were not available. 

Home Health Spending Begins To Climb Again Post-PandemicHome Health Care NewsDecember 13, 2023After stalling in 2021, spending on home health care returned to a more normalized growth rate in 2022, according to a new analysis from the Office of the Actuary at the Centers for Medicare & Medicaid Services. Specifically, national health expenditures on home health care increased by 6% to $132.9 billion in 2022. 

Home Health Industry Leaders Scoff At ‘Distorted Picture of Reality’ Painted By MedPACHome Health Care NewsDecember 12, 2023The Medicare Payment Advisory Commission recommended that the Medicare base payment rate for home health care be reduced by 7% for CY 2025. The recommendation is another chapter in the contentious relationship between the commission and the home health industry. It also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Operating in the redPuget Sound Business Journal (Seattle, WA)December 10, 2023... Across Washington, health systems representing 93% of the state’s beds have incurred more than $750 million in operational losses in the first half of 2023, according to data from the Washington State Hospital Association. ... Those losses were much steeper in 2022, but a majority of Washington hospitals are still operating at a deficit, burning through cash reserves to keep their doors open. Statewide, 17 hospitals have less than three months of operating costs in their reserves, per WSHA. ... “Folks have probably heard the term ‘no margin, no mission.’ So, no matter how foundational your mission statement is, if you don’t have the finances to run the organization, then there really can’t be a mission for you,” [EvergreenHealth Chief Medical and Quality Officer Dr. Ettorre] Palazzo said. ... As hospitals look for ways to stave off financial losses, they’re faced with another crisis—a population that is demonstrably sicker than it was prior to Covid 19. That’s leading to high hospital censuses and clogged emergency departments, further stressing hospital systems, employee well-being and financial viability.

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025. 

Forced to work in a vacuum, MedPAC recommends another Medicare cutMcKnight’s Long Term Care NewsDecember 11, 2023A Congressional advisory group appears ready to recommend a 3% Medicare pay cut for nursing homes in 2025. In what has become an annual tradition, members of the Medicare Payment Advisory Commission voiced ongoing concerns Friday about the use of Medicare Fee for Service reimbursement to effectively subsidize Medicaid rates and Medicare Advantage payments. With official data indicating that patients still have plenty of access to care, panel staff recommended MedPAC tell Congress that it should pursue a cut to Chair Michael Chernew, PhD, a healthcare policy professor at Harvard, said the 3% cut could be steeper given the reported margins. But the commission—tasked only with considering Medicare policy—remains cognizant of the pressures faced by providers accepting Medicaid and being increasingly low balled by managed care plans.

Here’s why you can’t die peacefully in Oklahoma.By Abby RemmingThe OklahomanDecember 6, 2023... Having Medicare or a Medicare Advantage plan would cover hospice, but many people have private insurance from work or state Medicaid plans. Private insurance and Medicaid Advantage plans at times can have a hospice benefit but limit which companies can be used. Applying for Medicare will ensure you are covered for hospice. ... I currently work as a hospital social worker and assist many people who need hospice. Many times, I have had to share with patients and their families that, while they may be ready to peacefully pass away, hospice coverage is not included in the patient’s current insurance plan. Providing end-of-life care is extremely difficult without the added burden of worrying whether insurance will cover the benefit. Those without the benefit and who need the service are then reliant upon the generosity of the companies to absorb the cost. If the Medicaid Advantage plan is picked, a person would need to decide if they wanted the benefit to either cover nursing home care or in-home hospice care. A Medicaid Advantage plan might not cover hospice even when the policyholder believes they have the benefit. 

Hospice Clinician Wages Rising at Slower Rate; Turnover FallingHospice NewsDecember 1, 2023Wages for hospice clinicians continue to go up amid widespread staff shortages, but they grew at a slower rate in 2023 compared to the prior year. The national average hourly rate for Hospice registered nurses rose 4.58% in 2023, down from a 5.95% increase in 2022, according to a new report by the Hospital & Healthcare Compensation Service in cooperation with the National Association for Home Care & Hospice. Meanwhile, turnover rates declined in 2023, representing the first drop in several years, the report indicated.