Literature Review

CMS announces updated Medicaid eligibility standards for 2025 McKnights Senior Living; by Lois A. Bowers; 1/17/25 The Centers for Medicare & Medicaid Services on Friday released an informational bulletin with updated federal poverty level standards applied to eligibility criteria for Medicaid. The 2025 guidelines reflect a 2.9% price increase between calendar years 2023 and 2024, the agency said. For 2025, the poverty guideline in all states except Alaska and Hawaii is $15,650 for a one-person family/household and $21,150 for a two-person family/household. The 2025 standards for individuals dually eligible for Medicare and Medicaid: [Click on the title's link to continue reading.]

Torrie Fields on palliative care and serious illness innovations Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux; 12/18/24 In this episode of TCNtalks, host Chris Comeaux interviews Torrie Fields, Founder & Chief Executive Officer, TFA Analytics, about her journey in the field of palliative care.  Torrie shares her insights on the importance of palliative care, innovations in reimbursement models, and the lessons learned from implementing palliative care programs in California and Hawaii. The conversation highlights the urgency for hospice organizations to adapt to changing healthcare landscapes by innovating in the serious illness and palliative care space and the need for effective partnerships with payers. Torrie emphasizes the importance of articulating the unique value propositions of palliative care services and offers strategies for hospice leaders to thrive in the future.

Palliative medicine for the community paramedic Journal of Emergency Medical Services (JEMS) - The Conscience of EMS; by Maurice Paquette; 12/17/24 The role of the paramedic is evolving. ... EMS has become a catch-all, a gateway into a somewhat—if not totally—fractured healthcare system. ... The landscape of healthcare is shifting as well. The pandemic, coupled with the realization of self-care, well-being, and mental health struggles has caused drastic reduction in the number of healthcare workers, and the amount of experience in skills that those healthcare workers carried with them. ... Over the past many years, we’ve seen a push for the idea of the community paramedic, as well as mobile healthcare. The establishment of a community paramedic program, especially in rural areas of the United States, would provide non-emergent care, under expanded scope and under the direction of a physician in the patient’s home.  According to a literature review in the International Journal of Paramedicine, the most common community paramedic program goals are to “aid patients in chronic disease management, reduce emergency department visits, reduce hospital admissions/readmissions, and reduce Healthcare costs.” Editor's note: Pair this with the article we posted yesterday, Characteristics of patients enrolled in hospice presenting to the emergency department.

20 Ways our healthcare system wastes money and prioritizes profits over patients World of DTC Marketing - Healthcare Insights; by Richard Meyer; 12/8/24 Every year, over a half million Americans go bankrupt—often losing pretty much everything they’ve worked their entire lives for—because someone in their family got sick. In 2018 alone, the United States wasted $ 256 billion on “administrative expenses” associated with for-profit health insurance, including multimillion-dollar salaries and armies of bean counters who scour claims looking for reasons to reject payment of hospital, doctor, and pharmaceutical bills. Our healthcare system wastes money and puts patients’ lives at risk. [The list includes:]

[CAPC] 2024 Serious Illness ScorecardCenter to Advance Palliative Care press release; 12/4/24America’s readiness to meet the needs of people with serious illness. A state-by-state look at palliative care capacity. How does your state rate? How can I improve my state’s rating? Download the full report.

40 largest health systems in the US | 2024 Becker's Hospital Review; by Laura Dyrda; 11/27/24 Some large health systems grew while others shrunk over the last year, and more consolidation could be ahead. But changes were minimal in either direction, and the largest health systems this year remain relatively similar to previous years. Becker's compiled a list of the largest health systems in the U.S. based on the number of hospitals reported on the system's website. ... Note: The list below is not a ranking. Data includes all hospitals within the system. [Click on the title's link for the full list of 40 health systems.]

How health system palliative providers can leverage data to gain more resources Hospice News; by Jim Parker; 11/12/24 Palliative care clinicians in health systems can apply research to lobby administrators for additional resources. In doing so, they may get a profile boost due to the COVID-19 pandemic. Palliative care’s reputation grew during the pandemic, with more patients and health care organizations recognizing its benefits and value. Stakeholders can leverage this in discussions with organization leaders, according to Dr. Tamara Vesel, chief of the Palliative Care Division at Tufts Medical Center and associate professor of medicine and pediatrics, Tufts University School of Medicine. ... When approaching organization leaders to advocate for palliative care, the importance of data cannot be overstated, according to study co-author Dr. Bernice Burkarth, chief medical officer of Tufts Medicine Care at Home and assistant professor of medicine at Tufts University School of Medicine.Editor's note: Reminder, our newsletter's Saturday edition always compiles relevant, timely research articles for you. To me, the word "research" means to "re-search," as in to search again--now--for the best information and appliciations available, today. We do alot of the work for you, re-searching and re-searching topics, pairing timely hospice and palliative challenges with formal research's background needs, research methods, data, references, conclusions, applications, and needs for further examination. 

Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program Hospice News; by Holly Vossel; 11/11/24 Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape. The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency. ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported. [Click on the title's link to continue reading.]

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.

HealthRev Partners and Trella Health announce partnership to empower home health and hospice agencies The Warren Record; by Trella Health; 10/17/24HealthRev Partners, [a] revenue cycle management partner specializing in innovative, tech-driven solutions for home health and hospice agencies, and Trella Health, [a] provider of market intelligence and Customer Relationship Management (CRM) solutions for the post-acute care industry, have announced a new partnership. HealthRev Partners and Trella Health will collaborate to help agencies reach their full potential by cultivating stronger relationships with referral sources and optimizing their revenue cycle through complementary solutions.

Spending on home healthcare outpaces others for 4th consecutive month McKnights Senior Living; by Kathleen Steele Gaivin; 9/26/24 Spending on home healthcare continued to outpace the rest of the sector in August, according to Altarum’s monthly Health Sector Economic Indicators brief, released Wednesday. “This is the fourth successive month in which we have observed such rapid growth. Year-over-year home healthcare spending growth for the four-month period from April through July was 19.7%,” George Miller, PhD, Altarum fellow and research team leader, told the McKnight’s Business Daily. Overall, healthcare costs were 2.7% higher last month than they were in August 2023 and 0.2% percent lower than they were in July, according to Altarum. ... Nursing and residential care employment, however, declined by 2,600 jobs in August. ...

The ‘Holy Grail’ of palliative care payment through ACOs Hospice News; by Jim Parker; 9/11/24 As opportunities to provide palliative care through Accountable Care Organization (ACO) relationships continue to arise, operators will likely need to understand the varying types of reimbursement that exist in that arena. ACOs are groups of physicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. Hospices and palliative care providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network. Community-based palliative care’s track record of reducing costs and hospitalizations could make providers of those services attractive to ACOs, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips, LLP.