Literature Review

Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care McKnights Long-Term Care News; by Josh Henreckson; 6/26/24 The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional leaders is urging. ...  Skilled nursing providers have been sounding the alarm for years on Medicare Advantage coverage access, especially when informed by AI and other algorithms. Sector leaders have frequently noted that these methods can deny or prematurely end coverage for patients who need it to afford necessary long-term care. Providers and consumer advocates both spoke out in favor of the lawmakers’ letter this week. “LeadingAge’s nonprofit and mission driven members … have firsthand experience of Medicare Advantage (MA) plans’ inappropriate use of prior authorization to deny, shorten and limit MA enrollees’ access to medically necessary Medicare benefits,” wrote Katie Smith Sloan, president and CEO of LeadingAge. ... “Implementation by [the] Centers for Medicare and Medicaid Services (CMS), which we fully support, would ensure MA plans fulfill their obligation to provide enrollees equitable access to Medicare services.”

HHS to impose penalties on providers that block patients’ health information McKnights Home Care; by Adam Healy; 6/24/24In a bid to promote easier access and exchange of patients’ health records, the Department of Health and Human Services published a final rule Monday outlining penalties for providers that block access to electronic health information. ... Fragmented and inaccessible patient data can prevent long-term and post-acute care providers from seeing the full picture of a patients’ health. Hospitals, for example, are not required to share updates about a patient’s health with the patient’s post-acute care provider. As a result, home health and home care agencies frequently cannot access patients’ electronic health records to help assess and treat patients. Three disincentives: ... First, hospitals that commit information blocking can be subject to a reduction of three quarters of an annual market basket update. Second, clinicians eligible for the Merit-based Incentive Payment System will receive a zero score in the “promoting interoperability performance” MIPS category, which can be equivalent to roughly a quarter of the clinician’s MIPS score in a given year. Lastly, providers that participate in information blocking can have their Medicare Shared Savings Program or Accountable Care Organization eligibility revoked for at least one year. ...Editor's Note: Almost any solution raises additional challenges. How does HIPAA interface with this? How might a cyberattack at a hospital (or other healthcare agency) affect the patients' other agencies, putting them at risk as well?

Garnet Health shutters palliative care program Hospice News; by Jim Parker; 6/25/24 New York state-based Garnet Health has announced a restructuring plan that spells the demise of its inpatient palliative care services. The plan includes layoffs of about 1% of the health system’s workforce, numbering 26 employees. This is estimated to save Garnett $4.6 million in salaries and benefits. “[Garnet] continues to be challenged with significant labor expenses, inflation on supplies and equipment, and low payor reimbursement rates,” the health system indicated in a statement. The restructuring is the result of financial headwinds, including decreased demand. Patient volumes are gradually increasing, but not yet to pre-pandemic levels, the company stated in an announcement.

The opportunity for palliative care in ACO Flex Palliative Care NEws; by Audrie Martin; 6/24/24 On Jan. 1, 2025, the Center for Medicare and Medicaid Services (CMS) Innovation Center will begin implementing a payment model for primary care known as the Accountable Care Organizations (ACOs) Primary Care Flex Model under the Medicare Shared Savings Program (MSSP). The ACO Flex Model is a voluntary initiative to improve funding and other resources to support primary care delivery within the MSSP. The model encourages the formation of new, physician-led ACOs, particularly those serving underserved communities and addressing health disparities. This program is not just a test but also seeks to empower participating ACOs and their primary care providers to employ more innovative, team-based, person-centered and proactive approaches to care. [Click on the title's link for more information.]

Children’s hospices risk being ‘hugely reduced’ due to funding and cost issues Jersey Evening Post - UK News; by UK News; 6/19/24 Children’s hospice services are at risk of being “hugely reduced” amid a lack of long-term sustainable funding and rising costs, a charity has warned. ... Some 66.7% of children’s hospices said this was due to a hike in energy bills, while 86.1% said it was due to higher costs associated with recruiting and retaining staff. According to the report, some 54% of children’s hospices in the UK ended the 2023/24 financial year in a net deficit. Together for Short Lives extrapolated the figure across all 39 hospice organisations to estimate a total shortfall of £8.5 million.

Global digital health outlook and growth report 2024: Care at home and alternative sites will see a growing preference, focus will be on adoption across clinical and operational use cases Classic 96.7 FM; by Business Wire; 6/17/24The digital health industry has maintained a consistent growth trajectory. Investing in technologies that help organizations achieve the quintuple aim of healthcare is a constant priority. However, high inflation and tight monetary policy will impact the investment landscape as it shifts from top-line growth to profitability. ... Change management initiatives will require stakeholder education to understand the pros and cons of newer technology initiatives and work alongside these to improve clinical and operational processes. Top 2024 Digital Health Predictions:

AAHPM CMO Joe Rotella: Hospice does not exist to save money Hospice News; by Jim Parker; 6/17/24Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM), calls on hospices to maintain their core principles amid a churning sea of regulatory and economic changes. Rotella began his medical career as a primary care physician in a small, rural town in central New Hampshire, where he stayed for 12 years [followed by serving Hospice & Palliative Care of Louisville, KY/Hosparus as Chief Medical director for 15 years]. ... Now, Rotella will soon retire from AAHPM. Hospice News sat down with Rotella to discuss the ways hospice and palliative care have changed during his tenure in the space, as well as the forces shaping the field’s future. ...

Advocates rally in DC for the future of hospice: NHPCO and HAN amplify provider voices on Capitol Hill NHPCO; Press Release; 6/13/24 More than 100 hospice and palliative care advocates from across the country met with over 150 congressional offices this week to discuss key legislative and regulatory priorities for ensuring and expanding access to hospice and palliative care. The meetings were part of Hospice Action Week, hosted in Washington, DC by the National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN). “The cornerstone of effective advocacy is storytelling. It’s about sharing why hospice holds personal significance and why serious illness and end-of-life care policy should resonate with our lawmakers,” said Logan Hoover, NHPCO’s VP of Policy & Government Relations. “From Hawaii to Rhode Island, advocates from 35 diverse states came to DC this year. The relationships they’re building with Members of Congress hold the potential to shape the future of the healthcare landscape.” 

Hawaiʻi is the first state to provide palliative care coverage EIN Presswire; by Governor JOsh Green, MD; 4/4/24 Governor Josh Green, M.D., and the Department of Human Services (DHS) Med-QUEST Division are pleased to announce that the Centers for Medicare and Medicaid Services (CMS) approved a new State Plan Amendment (SPA) to cover community palliative care services through Medicaid, making Hawaiʻi the first state in the nation to do so.  ... “After several years of hard work and collaboration with many community members and experts in the field, I am proud to announce that Med-QUEST is the first Medicaid program in the country to get this benefit approved,” said Governor Green. “This will greatly improve the quality of life and health outcomes for thousands of people who face serious medical conditions in our state. Hawaiʻi continues to lead the nation in innovations in health and health care.”  

Healthcare sees highest Chapter 11 bankruptcy filings in 15 years: reportMcKnights Senior Living; by Kathleen Steele Gaivin; 5/20/24Chapter 11 bankruptcies in healthcare, including senior living reached a multiyear high in the first quarter of 2024. That’s according to the newest Polsinelli-TrBK Distress Indices Report, published Wednesday. “We continue to see intense stress in senior living,” Jeremy R. Johnson, a bankruptcy and restructuring attorney at Polsinelli and co-author of the report, said in a press release issued in conjunction with the report. ... The Southeast continues to outpace the rest of the country as the busiest region for bankruptcy filings, according to the report. The Southeast region reported 33.4% of the filings in the first quarter, followed by Northeast and Delaware at 30.8% and 16.1%, respectively. Since the benchmark period of 2020, the Northeast has shown the biggest increase in filings.

How value-based models can aid palliative care team recruitment Hospice News; by Jim Parker; 5/22/24 A transition from fee-for-service to value-based payment models could help palliative care providers boost recruitment and retention. Providers walk a tightrope when it comes to ensuring that their palliative care services are financially sustainable, including the ability to attract and compensate staff at competitive rates. In today’s predominant reimbursement structure, palliative care programs are often loss leaders. But moving away from fee-for-service towards value-based payment could make a difference when it comes to hiring and retention, according to Dr. Jennifer Blechman, palliative care medical director at the Oregon-based nonprofit Partners in Care. ...

Senate ramps up push to reform doctors' Medicare pay Modern Healthcare; by Michael Mcauliff; 5/20/24Declining doctors' pay in Medicare is getting its most serious look in nearly a decade in the Senate, with a bipartisan push launched Friday by the Senate Finance Committee. Doctors have grown especially vocal in recent years about falling Medicare reimbursement. Groups including the American Medical Association have estimated doctors were effectively getting paid 26% less in 2023 than in 2001 because the physician fee schedule set by the Centers for Medicare and Medicaid Services is not adjusted for inflation. Physicians have also called for more flexibility within the pay system.