Literature Review

All posts tagged with “Palliative Care Provider News | Operations News | Financial.”



CMS’ TEAM Payment Model: What hospices need to know

06/02/25 at 02:00 AM

CMS’ TEAM Payment Model: What hospices need to know Hospice News; by Jim Parker; 5/30/25 A forthcoming alternative payment model for hospitals focuses on discharge planning and ensuring effective post-acute care, including hospice and palliative care when appropriate. The U.S. Centers for Medicare & Medicaid Services (CMS) late last year unveiled its new Transforming Episode Accountability Model (TEAM). Participation in the model will be mandatory for select hospitals. The program is set to launch on Jan. 1, 2026 and run through Dec. 31, 2030. CMS designed the program based on lessons learned from previous episode-based payment models, as well as input from stakeholders in response to a Request for Information published in 2023.  

Read More

Inside the Medicare Advantage Reform Act

05/29/25 at 03:00 AM

Inside the Medicare Advantage Reform Act Hospice News; by Jim Parker; 5/28/25 A bill currently before Congress seeks to overhaul aspects of the Medicare Advantage program. Rep. David Schweikert (R-Ariz.) recently introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA). A key provision of the bill is a proposed requirement that MA plans pay for hospice care. Hospice is currently “carved out” of Medicare Advantage. The potential impacts of moving hospice into MA at this time would be “devastating,” according to the National Alliance for Care at Home. ... [Other] changes to MA included in the text could have serious implications for hospices and other providers that also offer home health, palliative care or other services. ...

Read More

Care transformation in palliative care: Leveraging a payor-provider partnership to fast-track growth of a palliative program

05/24/25 at 03:40 AM

Care transformation in palliative care: Leveraging a payor-provider partnership to fast-track growth of a palliative programJournal of Palliative Medicine; Emily Jaffe, Emily Hobart, Alexandra Aiello, Amber Shergill, Amanda Harpster-Hagen, Tyson S. Barrett; 5/25This study describes a unique partnership between an insurer and a provider to enhance the quality, availability, and access to palliative services. A retrospective cohort analysis of insurance claims data for patients receiving palliative care compared to a matched cohort not receiving palliative care services from 2019 through 2022. Outcomes demonstrated a total savings of $4,526,408 through reductions in costs for the treatment group compared to the control group for total cost of care ...., inpatient stays ($5,672 ... ) , outpatient visits ($229 ... ), professional claims ($1,243 ... ), and pharmacy fills ($17 ... ). The treatment group had lower skilled nursing facility ($1,049 ... ) and inpatient rehabilitation facility ($216 ... ) costs. The treatment group had higher rates of hospice care (83.7% in the treatment compared to 50.2% ... ) but had lower lengths of stay (four days compared to five ... ).Conclusions: Collaborative investment in a palliative program by a payor and provider system shows significant financial savings for an insurer when patients receive evidence-based palliative care near the end of life.

Read More

Securing philanthropic support for palliative care

05/23/25 at 03:00 AM

Securing philanthropic support for palliative care Hospice News; by Markisan Naso; 5/21/25 Fundraising has long been a necessity for many nonprofit organizations to provide palliative care programs. Currently, Medicare payment for palliative care only covers physician or licensed independent practitioner services and does not support the full range of interdisciplinary care, involving nurses, chaplains, aides and social workers. This shortage of funds has made community-based palliative care into a loss leader for many organizations. Palliative care is among the most “underfunded” services in the health care continuum, according to Deborah Johnson, chief philanthropy officer at Empath Health, a large non-profit post-acute care organization in Florida.

Read More

Podcast: Innovations and insights in the palliative care space

05/21/25 at 03:00 AM

Podcast: Innovations and insights in the palliative care space Holland & Knight; podcast by Daniel Patten and Spencer Freeman; 5/20/25 In this episode of "Counsel That Cares," Daniel Patten, a partner in Holland & Knight's Healthcare Regulatory & Enforcement Practice, and Spencer Freeman, chief strategy officer at Gentiva, discuss the challenges and opportunities that come with delivering integrated palliative care services, highlighting the lack of a defined Medicare benefit for palliative care compared to more established models such as hospice. Mr. Freeman shares insights on building care models that serve high-risk patient populations through coordinated interdisciplinary teams and data-driven approaches, emphasizing the importance of collaboration with risk-based primary care providers. Mr. Patten adds a legal perspective on the evolving landscape of value-based care contracts, artificial intelligence (AI) integration and regulatory compliance. Together, they explore how innovative programs can improve patient outcomes, reduce acute care utilization and facilitate payer relationships, offering a comprehensive view of the future of palliative care within value-based healthcare delivery.

Read More

Downside risk, upside payment highlight new CMS innovation agenda

05/14/25 at 02:00 AM

Downside risk, upside payment highlight new CMS innovation agendaModern Healthcare; by Bridget Early; 5/13/25The Centers for Medicare and Medicaid Services is rolling out a broad new agenda for its innovation center that could lead to requirements that participants in value-based care programs to take on downside risk, the agency announced ... The Center for Medicare and Medicaid Innovation plan prioritizes shared risk and prospective payments, streamlined quality measurement, artificial intelligence and other technologies, and Medicare Advantage payment models, Director Abe Sutton said in an interview Friday [5/9]. Notably, CMS is walking away from a goal set four years ago to have all fee-for-service Medicare beneficiaries under accountable care arrangements by 2030, Sutton said. CMS provided Modern Healthcare an advance look at the new innovation center platform. ... Designing models that require providers to accept at least some downside risk could be the most consequential action stemming from the plan. Subjecting participants to potential financial losses, not just potential benefits, is key to driving cost savings and quality improvement, Sutton said.

Read More

Do automated reminders decrease no-show visits in an outpatient palliative medicine clinic?

04/23/25 at 03:00 AM

Do automated reminders decrease no-show visits in an outpatient palliative medicine clinic? Sage Journals - American Journal of Hospice and Palliative Medicine; by Ruth L. Lagman, MD, MPH, MBA, Renato V. Samala, MD, MHPE, Ahed Makhoul, MD, Kyle Neale, DO, Chirag Patel, MD, Elizabeth Weinstein, MD, Wei Wei, MS, and Xiaoying Chen, MS; 3/23/25 Individuals who do not show up for medical appointments can lead to unfavorable outcomes for both patients and health systems. Automated methods are available to confirm appointments in addition to patient service coordinator (PSC) telephone calls. This study aims to determine the no-show rates for automated methods of confirmation, in-person and virtual visits, and patients living in underserved areas.Conclusion: PSC telephone calls, individuals living within COZ and virtual visits had higher no-show rates.

Read More

HHS proposal slashes Medicare SHIP funds

04/23/25 at 03:00 AM

HHS proposal slashes Medicare SHIP funds MSN; by Mary Helen Gillespie; 4/22/25 The Trump administration is proposing federal budget cuts to Medicare State Health Insurance Assistance Programs (SHIP) and seven additional elder health care safety net programs that assist older Americans. ... SHIP programs have been under the umbrella of the Health and Human Services agency Administration for Community Living. The pre-decisional budget lists funds for seven other ACL programs that would be eliminated are:

Read More

American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model

04/23/25 at 03:00 AM

American Oncology Network achieves success in first performance period of CMMI’s enhancing oncology model Stock Titan, Globe Newswire, Fort Myers, FL; 4/22/25 American Oncology Network (AON), one of the nation’s fastest-growing community oncology networks, today announced strong results from the first performance period in the Centers for Medicare & Medicaid Innovation’s (CMMI) Enhancing Oncology Model (EOM). AON practices participating in the program—in collaboration with value-based cancer care enabler Thyme Care—achieved nearly $6M in cost savings for the Centers for Medicare & Medicaid Services (CMS). AON also earned a performance-based payment while improving patient experience and outcomes.

Read More

Value-based palliative care moving toward risk-based models

04/22/25 at 03:00 AM

Value-based palliative care moving toward risk-based models Hospice News; by Jim Parker; 4/21/25 Risk-based contracts may be the future of palliative care reimbursement as Medicare Advantage continues to ascend. The simple term “value-based care” belies its complexity. The term can refer to any number of payment models that are designed to reduce total cost of care and improve outcomes. While most palliative care remains locked in the fee-for-service realm, most value-based organizations like MA plans are moving towards it, according to Dr. Gavin Baumgardner, vice president and national medical director for complex and palliative care at Contessa Health, a subsidiary of Amedisys (Nasdaq: AMED). 

Read More

CMS drops 5 proposed payment rules for 2026: 25 things to know

04/15/25 at 02:00 AM

CMS drops 5 proposed payment rules for 2026: 25 things to knowBecker's Hospital Review; by Alan Condon; 4/11/25 CMS has released proposed payment rules for inpatient and long-term care hospitals, hospices and inpatient rehabilitation, psychiatric and skilled nursing facilities in fiscal year 2026. Twenty-five things to know: ...

Read More

Medicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements

04/02/25 at 03:00 AM

Medicare Administrative Contractors [MACs] did not consistently meet Medicare Cost Report Oversight Requirements HHS-OIG; Issued on 3/18/25, posted on 3/19/25 ... What OIG Found: MACs did not consistently meet Medicare cost report oversight requirements.

Read More

Health system CFOs fight for Medicaid on Capitol Hill

04/02/25 at 03:00 AM

Health system CFOs fight for Medicaid on Capitol Hill Becker's Hospital Reivew; by Alan Condon; 3/31/25 Multiple health system CFOs recently traveled to Washington, D.C., to meet with lawmakers on Capitol Hill, advocating against proposed Medicaid cuts that could threaten access to care and lead to the closure of essential hospital services. Health system executives participating in these discussions included:

Read More

Evaluation of the Medicare Advantage Value-Based Insurance Design model test: 2020 to 2023

03/31/25 at 02:00 AM

Evaluation of the Medicare Advantage Value-Based Insurance Design model test: 2020 to 2023  RAND Health Care, prepared for the Centers for Medicare & Medicaid Services Center for Medicare and Medicaid Innovation Under Research, Measurement, Assessment, Design, and Analysis Contract Number 75FCMC19D0093, Order Number 75FCMC20F0001; by Christine Eibner, Dmitry Khodyakov, Erin A. Taylor, Denis Agniel, Rebecca Anhang Price, Julia Bandini, Marika Booth, Lane F. Burgette, Christine Buttorff, Catherine C. Cohen, Stephanie Dellva, Michael Dworsky, Natalie C. Ernecoff, Alice Y. Kim, Julie Lai, Monique Martineau, Nabeel Qureshi, Afshin Rastegar, Max Rubinstein, Daniel Schwam, Joan M. Teno, Anagha Tolpadi, Shiyuan Zhang; March 2025 This report presents RAND researchers’ findings from their evaluation of the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model test for 2020 through 2023, initiated by the Center for Medicare and Medicaid Innovation (Innovation Center). The VBID Model allows participating MA parent organizations (POs) to offer supplemental benefits, financial and nonfinancial incentives to beneficiaries, hospice benefits (the Medicare Hospice Benefit, Palliative Care, Transitional Concurrent Care, and Hospice Supplemental Benefits), and Wellness and Health Care Planning through their MA plans.

Read More

Charting the path forward to Value-Based Care

03/26/25 at 03:00 AM

Charting the path forward to Value-Based Care Forbes; by David Snow, Jr.; 3/25/25 The U.S. healthcare system is at a crossroads, embarking on a crucial transformation in how care is financed. For decades, we've operated under a fee-for-service (FFS) model, which incentivizes service volume with little accountability for efficacy or costs. According to the Commonwealth Fund, this model contributes to poor healthcare access, lower care quality and lack of care continuity and is a factor behind the staggering per-capita healthcare costs in the U.S., which are the highest in the world. ... In recent years, we've seen a shift away from the FFS model to progressive value-based care (VBC) models that link provider payments to patient outcomes, care quality and cost efficiency. This is a fundamental overhaul of healthcare economics, and although it may be challenging and disruptive, I believe it's essential. [Continue reading ...]

Read More

Bringing palliative care to every patient with cancer: A conversation with Janet L. Abrahm, MD, FACP, FAAHPM, FASCO

03/25/25 at 03:00 AM

Bringing palliative care to every patient with cancer: A conversation with Janet L. Abrahm, MD, FACP, FAAHPM, FASCO The ASCO Post, in partnership with the American Society of Clinical Oncology; by Jo Cavallo; 3/25/25 Janet L. Abrahm, MD, FACP, FAAHPM, FASCO, ... has become a widely recognized leader in the field of supportive care and palliative medicine, serving for nearly a decade on the leadership team of the American Academy of Hospice and Palliative Medicine and helping to craft the first Hospice and Palliative Medicine certifying examination offered by the American Board of Internal Medicine. ... In a wide-ranging interview with The ASCO Post, Dr. Abrahm discussed the importance of providing every patient with cancer access to palliative medicine throughout survivorship, how oncologists can become more effective communicators, and strategies to alleviate patients’ suffering at the end of life.

Read More

Community health workers and technology interventions' impact on palliative support globally: A Scoping Review of Randomized Controlled Trials

03/24/25 at 03:00 AM

Community health workers and technology interventions' impact on palliative support globally Journal of Palliative Medicine; by Alekhya Gunturi, Margarita Pertierra, Irma Elizabeth Huayanay Espinoza, Maya Kavita Ramachandran, Mpho Ratshikana Moloko, Karl A Lorenz; 3/20/25Background: Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings.  Conclusions: CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.Editor's note: Pair this with Hospice community responds to proposed DEA telehealth prescribing rule, posted 3/21/25.

Read More

More care doesn't equal happier patients in traditional Medicare

03/20/25 at 03:00 AM

More care doesn't equal happier patients in traditional Medicare American Journal of Managed Care (AJMC); by Maggie L. Shaw; 3/17/25 The extremes of health care contact days—having too few or more than average—among community-dwelling beneficiaries 65 years and older of traditional Medicare have been associated with unnecessary care, misdirected care coordination, and excessive care outside the home, according to new research published online today in JAMA Internal Medicine. Health care contact days are days spent receiving care outside of the home. ... “Clinicians, researchers, and policymakers could use contact days to evaluate interventions and reduce excess contact days for patients,” the authors conclude, “by avoiding unnecessary care, improving care coordination, and shifting care to the home.”

Read More

Oz does not rule out Medicaid cuts during Senate confirmation hearing

03/19/25 at 03:00 AM

Oz does not rule out Medicaid cuts during Senate confirmation hearing McKnights Home Care; by Adam Healy; 3/14/25 Mehmet Oz, MD, President Donald Trump’s pick to lead the Centers for Medicare & Medicaid Services, did not give a direct answer when asked whether he was for or against Medicaid cuts Friday during a Senate Finance Committee hearing. “I cherish Medicaid and I’ve worked within the Medicaid environment quite extensively practicing at Columbia University,” Oz said when asked by Sen. Ron Wyden (D-OR) if he would oppose cuts to Medicaid. “I want to make sure that patients today and in the future have resources to protect them if they get ill. The way you protect Medicaid is by making sure it’s viable at every level, which includes having enough practitioners to afford the services, paying them enough to do what you request of them, and making sure that patients are able to actually use Medicaid.”

Read More

MedPAC recommends Congress tie physician pay to inflation for 2026

03/19/25 at 03:00 AM

MedPAC recommends Congress tie physician pay to inflation for 2026 Healthcare Dive; by Susanna Vogel; 3/17/25 Dive Brief:

Read More

Pharmacies of the future: 4 keys to reinvention

03/18/25 at 03:00 AM

Pharmacies of the future: 4 keys to reinventionForbes; by Jenn Vande Zande; 3/11/25... “To continue to meet growing patient needs, we must evolve how community pharmacy works and, most importantly, how we support our pharmacy teams to create a sustainable future for community pharmacy,” Prem Shah, president of pharmacy and consumer wellness at CVS Health, said, referring to findings from the company’s Rx Report from January 2024. Based on those findings, CVS says there’s a “critical need for sustainable and scalable industry-wide change, such as operational improvements and digital innovations to better support pharmacy teams behind the counter.” Here are four focus areas for pharmacies to bring about that change:

Read More

2010 to 2019 saw early palliative care billing up for advanced cancer

03/18/25 at 03:00 AM

2010 to 2019 saw early palliative care billing up for advanced cancer HealthDay News; by Elana Gotkine; 3/17/25 For patients with distant-stage cancers, there was an increase in early palliative care (PC) billing from 2010 to 2019, but the level remained low, according to a study published online March 7 in the Journal of Clinical Oncology. ... The researchers found that in 2010 to 2019, there was an increase in the percentage with early PC billing among 102,032 patients treated by 18,908 unique physicians, from 1.44 to 10.36 percent. The likelihood of early PC billing was increased in association with treating physician's early PC referrals in the previous year and organizations' employment of any HPM specialist (3.01 and 4.54 percentage points, respectively). 

Read More

Enloe Health to transition Palliative Care Program to new cancer center

03/10/25 at 03:00 AM

Enloe Health to transition Palliative Care Program to new cancer center Action News Now, Chico, CA; by Matt Wreden; 3/7/25 Enloe Health is transitioning its Palliative Care Program to function under its soon-to-open cancer center. This shift means that Enloe Health will be phasing out its in-home palliative care services, a decision that has raised concerns within the local community. ... Enloe Health explained that this move is in line with the upcoming Symptom Management Clinic set to open as part of the new Cancer Center. Editor's note: Does this limit their palliative care services to only those with cancer? What about palliative care needs for persons with advanced heart disease? Strokes? Neurological diseases like ALS or Parkinson's? Advanced dementia?

Read More

House sets up potential Medicaid cuts with budget bill passage

02/28/25 at 03:00 AM

House sets up potential Medicaid cuts with budget bill passage Modern Healthcare; by Michael McAliff; 2/25/25 Republicans in the House took the first step Tuesday [2/25] toward steep potential healthcare cuts, passing a budget resolution that aims to trim spending by at least $1.5 trillion while also adding trillions to the debt to fund tax cuts. The House voted 217-215 on nearly party lines to begin what is known as budget reconciliation, passing a budget resolution that instructs committees to come up with cuts or extend tax cuts that largely benefit the wealthy. The bill mandates the House Energy and Commerce Committee, which oversees Medicaid and Medicare, come up with the majority of the savings, and cut $880 billion.

Read More

WesleyLife at Home expands services with palliative program

02/27/25 at 03:00 AM

WesleyLife at Home expands services with palliative program Hospice News; by Kristin Easterling; 2/26/25 Des Moines, Iowa-based WesleyLife at Home has launched the area’s first home-based palliative care program. The organization is the fourth-largest home health provider in the state, according to Aaron Wheeler, vice president of home and community-based services. While analyzing their home health census, the organization identified a significant number of patients with chronic medical conditions who required an additional level of care.

Read More